Provider Demographics
NPI:1760566426
Name:WARDLE, DARREN J (DPM)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:J
Last Name:WARDLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 216TH ST SW STE 320
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8006
Mailing Address - Country:US
Mailing Address - Phone:425-673-3900
Mailing Address - Fax:425-673-3910
Practice Address - Street 1:7320 216TH ST SW STE 320B
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-775-6996
Practice Address - Fax:425-670-8905
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000411213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
480031524OtherMEDICARE RR
WAWA4712OtherREGENCE RIDER
40316OtherL AND I
T91458Medicare UPIN
40316OtherL AND I
WA3914280001Medicare NSC