Provider Demographics
NPI:1780264200
Name:WAHL, GARRETT EVAN (MD)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:EVAN
Last Name:WAHL
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 1:8357 11TH AVE NW # A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3340
Mailing Address - Country:US
Mailing Address - Phone:402-580-0744
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST # BB-928
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-2849
Practice Address - Country:US
Practice Address - Phone:206-685-0936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMDRE.ML.61291152208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation