Provider Demographics
NPI:1790869030
Name:MUELLER, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:MUELLER
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 1:5929 EVERGREEN WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-6031
Mailing Address - Country:US
Mailing Address - Phone:425-258-4361
Mailing Address - Fax:425-259-5270
Practice Address - Street 1:5929 EVERGREEN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-6031
Practice Address - Country:US
Practice Address - Phone:425-258-4361
Practice Address - Fax:425-259-5270
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1160464Medicaid
WAR32456OtherREGENCE
WA1160464Medicaid
WAR32456OtherREGENCE