Provider Demographics
NPI:1760853550
Name:WILLIAM BACKLUND MD
Entity Type:Organization
Organization Name:WILLIAM BACKLUND MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-406-6717
Mailing Address - Street 1:23736 NE 116TH PL
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-5611
Mailing Address - Country:US
Mailing Address - Phone:425-406-6717
Mailing Address - Fax:
Practice Address - Street 1:23736 NE 116TH PL
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-5611
Practice Address - Country:US
Practice Address - Phone:425-406-6717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00011230207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1039502Medicaid