Provider Demographics
NPI:1972759058
Name:MADSEN, PAUL ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:MADSEN
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 1:19011 W VALLEY HWY
Mailing Address - Street 2:SUITE A-103
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-2108
Mailing Address - Country:US
Mailing Address - Phone:425-656-8008
Mailing Address - Fax:
Practice Address - Street 1:19011 W VALLEY HWY
Practice Address - Street 2:SUITE A-103
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2108
Practice Address - Country:US
Practice Address - Phone:425-656-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD20444208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice