Provider Demographics
NPI:1306186275
Name:TWADDLE, BRUCE C (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:C
Last Name:TWADDLE
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:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:3800 MONTLAKE BLVD
Practice Address - Street 2:ROOM 148B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0007
Practice Address - Country:US
Practice Address - Phone:206-543-1552
Practice Address - Fax:206-543-6573
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATR60365934207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine