Provider Demographics
NPI:1386751303
Name:WENDT, JOHN S (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:WENDT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:34503 9TH AVE S
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8726
Mailing Address - Country:US
Mailing Address - Phone:253-838-3103
Mailing Address - Fax:253-838-7134
Practice Address - Street 1:34503 9TH AVE S
Practice Address - Street 2:SUITE 230
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8726
Practice Address - Country:US
Practice Address - Phone:253-838-3103
Practice Address - Fax:253-838-7134
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2011-05-05
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Provider Licenses
StateLicense IDTaxonomies
WA253382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1046119Medicaid
WA0220092OtherSTATE L&I
A14928Medicare UPIN
WA1046119Medicaid
WA0220092OtherSTATE L&I