Active NPI
Wayne J Wallis, MD
- Rheumatology Physician
- Seattle, WA
National Provider Identifier
1962623959
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- MD00019116
- Practice address
- 2339 Federal Ave E
Seattle, WA 98102-4031 - Phone
- (206) 724-4401
- NPI assigned
- May 1, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | MD00019116 | WA | Primary |
Addresses
Primary practice location
2339 Federal Ave E
Seattle, WA 98102-4031
Mailing address
2339 Federal Ave E
Seattle, WA 98102-4031
Phone (206) 724-4401
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8574600 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00019116 | WA | MD | Rheumatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441238400000",
"number": "1962623959",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2339 FEDERAL AVE E",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981024031",
"telephone_number": "206-724-4401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2339 FEDERAL AVE E",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981024031",
"telephone_number": "206-724-4401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLIS",
"first_name": "WAYNE",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2015-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "WA",
"license": "MD00019116",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8574600",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.