Provider Demographics
NPI:1891868535
Name:WURST, TOD EVANS (MD)
Entity type:Individual
Prefix:
First Name:TOD
Middle Name:EVANS
Last Name:WURST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1911
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-383-3553
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000297802085R0204X
WAMD000297802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA81554OtherLABOR AND INDUSTRIES/WC TRA
WA8944812OtherLABOR AND INDUSTRIES CRIME VICTIMS-TRA
WAG8881792OtherPTAN-MIO1
WA8945541OtherLABOR AND INDUSTRIES CRIME VICTIMS-UNION AVENUE OPEN MRI
WAAB36540OtherMEDICARE PIN TRA KING COUNTY
WA0249543OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WA8140253Medicaid
WAWU0000OtherREGENCE BLUE SHIELD TRA
WA8951861OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WA300024506OtherRR MEDICARE TRA
WA0260001OtherLABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
WA300024506OtherRR MEDICARE TRA
WAG8881792OtherPTAN-MIO1