Provider Demographics
NPI:1699736579
Name:AMIDON, THOMAS MORTON (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MORTON
Last Name:AMIDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:MS 315010
Mailing Address - Street 2:PO BOX 3947
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3947
Mailing Address - Country:US
Mailing Address - Phone:425-467-3655
Mailing Address - Fax:406-257-8996
Practice Address - Street 1:1135-116TH AVENUE NE
Practice Address - Street 2:SUITE 600
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-454-2656
Practice Address - Fax:425-455-2620
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12295207RC0000X
WAMD00033351207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2002512Medicaid