| Doctor Name: | MATTHEW GARY WADDINGHAM |
| NPI Number: | 1538467329 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CO |
| License Number: | OI60206377 |
| Business Practice Address: | 34709 9th Ave S Suite A-100 Federal Way, WA - 980038722 |
| Business Phone Number: | 2539523887 |
| Business Fax Number: | 2539273058 |
| Mailing Address: | 1901 S Cedar St, Suite 202 TACOMA |
| State: | WA |
| Postal Code: | 984052308 |
| Phone Number: | 2535721282 |
| Fax Number: | 2535721175 |
| NPI Enumeration Date: | 03/03/2011 |
| NPI Last Update Date: | 03/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | OI60206377 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |