Individual provider · NPI-1

Theodore Crisostomo-Wynne, MD

Urology · Tacoma, WA

NPI number1316486186
StatusActive
Last updated in NPPESOct 15, 2026

Details

NPI
1316486186
Entity type
Individual (NPI-1)
Name
Theodore Crisostomo-Wynne
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Feb 14, 2017
Certification date
Oct 15, 2026
Last updated
Oct 15, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208800000X UrologyMD61305294WAYes

Practice location

Madigan Army Medical Center 9040 Jackson Ave
Tacoma, WA 98431-0001

Phone 253-968-1110

Mailing address

Po Box 50095
Seattle, WA 98145-5095

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