Provider Demographics
NPI:1871515619
Name:BARDIN, EARL DAN (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:DAN
Last Name:BARDIN
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 1:4225 HOYT
Mailing Address - Street 2:STE C
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203
Mailing Address - Country:US
Mailing Address - Phone:425-252-2313
Mailing Address - Fax:425-258-1182
Practice Address - Street 1:4225 HOYT
Practice Address - Street 2:STE C
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203
Practice Address - Country:US
Practice Address - Phone:425-252-2313
Practice Address - Fax:425-258-1182
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWH20734208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB2037566OtherDEH
20734OtherWA STATE
WA1027812Medicaid
AB39659Medicare ID - Type Unspecified
WA1027812Medicaid