Provider Demographics
NPI:1710946108
Name:DAWOOD, AYAD JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:AYAD
Middle Name:JOSEPH
Last Name:DAWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 POTTERY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3768
Mailing Address - Country:US
Mailing Address - Phone:360-895-5000
Mailing Address - Fax:877-516-9023
Practice Address - Street 1:15 SW EVERETT MALL WAY
Practice Address - Street 2:SUITE A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-2715
Practice Address - Country:US
Practice Address - Phone:424-348-6727
Practice Address - Fax:877-860-2291
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01574099OtherRAILROAD MEDICARE-DV4997
WA1092571Medicaid
WAG8946224-EFF10/12/15Medicare UPIN