Provider Demographics
NPI:1861486516
Name:CARDWELL, THOMAS RAY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RAY
Last Name:CARDWELL
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 1:21600 HWY 99
Mailing Address - Street 2:SUITE 290
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8012
Mailing Address - Country:US
Mailing Address - Phone:425-778-0191
Mailing Address - Fax:425-672-2110
Practice Address - Street 1:21600 HWY 99
Practice Address - Street 2:SUITE 290
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8012
Practice Address - Country:US
Practice Address - Phone:425-778-0191
Practice Address - Fax:425-672-2110
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000144832080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine