Provider Demographics
NPI:1215955901
Name:WAUGH, WILLIAM WINSTON SR (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WINSTON
Last Name:WAUGH
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 NE 10TH PL STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2487
Mailing Address - Country:US
Mailing Address - Phone:425-450-2020
Mailing Address - Fax:425-688-0620
Practice Address - Street 1:12301 NE 10TH PL STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2487
Practice Address - Country:US
Practice Address - Phone:425-450-2020
Practice Address - Fax:425-688-0620
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1170207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B18173Medicare UPIN
WAG8868289Medicare PIN