Provider Demographics
NPI:1992852578
Name:LAU, WAYNE M (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:M
Last Name:LAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 59028
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2028
Mailing Address - Country:US
Mailing Address - Phone:425-251-5110
Mailing Address - Fax:425-793-7458
Practice Address - Street 1:4011 TALBOT RD S
Practice Address - Street 2:STE 420
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5773
Practice Address - Country:US
Practice Address - Phone:425-251-1322
Practice Address - Fax:425-656-4063
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033753208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA109517OtherDEPT OF L&I
WA1024043Medicaid
WA217127001Medicare PIN
WAG26581Medicare UPIN