Provider Demographics
NPI:1720013022
Name:WAHL, DAVID V (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:V
Last Name:WAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11911 NE 132ND ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-899-5800
Mailing Address - Fax:425-899-5806
Practice Address - Street 1:11911 NE 132ND ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-899-5800
Practice Address - Fax:425-899-5806
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11642208800000X
WAMD11642208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA55329GOtherMEDICARE ID-PIN
WA11642OtherMEDICAL LICENSE
WA1193309Medicaid
A55329Medicare UPIN
105668Medicare PIN