Who is Dr. Trumble, Orthopedic Hand Surgeon in Bellevue, WA?
Dr. Thomas Trumble, MD is an Orthopedic Hand Surgeon, who primarily practices in Bellevue, WA. He has been practicing for over 47 years and is board certified. Dr. Trumble completed his residency at Duke Univ Med Ctr, Hand Surgery; Yale New Haven Hosp, Orthopedic Surgery; Yale New Haven Hosp, General Surgery. He is a member of the American Academy of Orthopaedic Surgeons.
Dr. Trumble is fluent in English and Spanish, and is currently seeing new patients. Dr. Trumble’s practice accepts Medicare, UnitedHealthcare, Cigna and other major insurance plans. To book an appointment or to confirm insurance options, please call Dr. Trumble’s office at (425) 999-3580.
What are Areas of Expertise for Dr. Trumble?
Dr. Thomas Trumble, MD is a highly-rated, board-certified Orthopedic Hand Surgeon known for expertly diagnosing, treating, and managing a wide array
of related conditions or procedures. Utilizing the latest medical advancements and evidence-based practices, Dr. Trumble empowers
patients to confidently navigate their health journey, specializing in Elbow Surgery, Hand & Wrist Surgery, Nerve Disorders/Surgery, Upper Extremity Trauma, or comprehensive
wellness support. Serving
the Bellevue/WA community, Dr. Trumble is dedicated to enhancing lives through expert, patient-centered care.
Where did Dr. Trumble go to medical school and complete their residency?
Residency: Duke Univ Med Ctr, Hand Surgery; Yale New Haven Hosp, Orthopedic Surgery; Yale New Haven Hosp, General Surgery
Medical School: Yale University School of Medicine
Is Dr. Trumble board certified as an Orthopedic Hand Surgeon?
Yes, Dr. Thomas Trumble, MD is board certified by the American Board of Orthopaedic Surgery
What languages does Dr. Trumble speak?
Dr. Trumble and their clinical team can communicate with patients in the following languages:
English
Spanish
What conditions does Dr. Trumble treat?
As an Orthopedic Hand Surgeon, Dr. Trumble diagnoses, treats, and manages
a wide range of conditions. This condition information is derived from anonymized
insurance claims and highlights the medical conditions most commonly treated
by Dr. Trumble. It provides insight into the doctor’s areas of experience
and expertise based on real-world patient encounters from the past two years, updated quarterly.
Also known as:
Primary Osteoarthritis in Right Thumb Base
Osteoarthritis of the left thumb joint
Osteoarthritis of the right hand
Osteoarthritis
Right Thumb Arthritis
Primary Right First CMC Joint Arthritis
Right Hand Thumb Base Osteoarthritis
Degenerative joint disease
Wear-and-tear arthritis
Arthrosis
Joint degeneration
Degenerative Joint Disease
Wear-and-Tear Arthritis
Hand Arthritis
ICD-10 Codes:
M1811: Unilateral primary osteoarthritis of first carpometacarpal joint, right hand
M1812: Unilateral primary osteoarthritis of first carpometacarpal joint, left hand
M19041: Primary osteoarthritis, right hand
M19042: Primary osteoarthritis, left hand
M1852: Other unilateral secondary osteoarthritis of first carpometacarpal joint, left hand
Also known as:
Right Carpal Tunnel Syndrome
Left Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Right Wrist Nerve Compression
Right Hand Numbness
Right CTS
Left Wrist Nerve Compression
Left Hand Numbness
Left CTS
ICD-10 Codes:
G5601: Carpal tunnel syndrome, right upper limb
G5602: Carpal tunnel syndrome, left upper limb
Also known as:
Dupuytren's Contracture
Connective Tissue Disorder
Finger Injuries and Disorder
Dupuytren contracture
Palmar fibromatosis
Viking disease
Hand contracture
ICD-10 Codes:
M720: Palmar fascial fibromatosis [Dupuytren]
Also known as:
De Quervain's Tenosynovitis
Hand Injuries and Disorder
Tendinitis
De Quervain's Disease', 'Washerwoman's Sprain
Radial Styloid Tenosynovitis
ICD-10 Codes:
M654: Radial styloid tenosynovitis [de Quervain]
Also known as:
Trigger Left Middle Finger
Trigger Right Middle Finger
Finger Injuries and Disorder
Tendinitis
Stenosing Tenosynovitis of Left Middle Finger
Left Middle Finger Tendonitis
Snapping Left Middle Finger
Stenosing Tenosynovitis of Right Middle Finger
Right Middle Finger Tendonitis
Snapping Right Middle Finger
ICD-10 Codes:
M65332: Trigger finger, left middle finger
M65331: Trigger finger, right middle finger
Also known as:
Trigger Thumb
Finger Injuries and Disorder
Tendinitis
Stenosing Tenosynovitis of Thumb
Thumb Tendonitis
Thumb Locking
ICD-10 Codes:
M65311: Trigger thumb, right thumb
Also known as:
Right Hand Ganglion Cyst
Connective Tissue Disorder
Right Hand Synovial Cyst
Lump on Right Hand
Right Hand Ganglion
ICD-10 Codes:
M67441: Ganglion, right hand
Also known as:
Ulnar Nerve Damage
Peripheral Nerve Disorder
Ulnar Neuropathy
Cubital Tunnel Syndrome
ICD-10 Codes:
G5622: Lesion of ulnar nerve, left upper limb
Also known as:
Pre-Procedure Lab Tests
Pre-op blood work
Lab tests before surgery
Pre-treatment lab assessment
ICD-10 Codes:
Z01812: Encounter for preprocedural laboratory examination
Also known as:
Benign Soft Tissue Tumor of the Right Arm and Shoulder
Benign Tumor
Non-cancerous right arm growth
Benign right shoulder mass
Non-malignant right upper limb tumor
Benign growth in right arm
ICD-10 Codes:
D2111: Benign neoplasm of connective and other soft tissue of right upper limb, including shoulder
Also known as:
Left Radius Fracture (Wrist Joint)
Arm Injuries and Disorder
Fractures
Broken Left Wrist
Left Arm Fracture
Intraarticular Radius Fracture
ICD-10 Codes:
S52572D: Other intraarticular fracture of lower end of left radius, subsequent encounter for closed fracture with routine healing
Also known as:
Right Wrist Sprain
Sprains and Strains
Wrist Injuries and Disorder
Twisted right wrist
Right wrist ligament injury
Right wrist strain
Sprained right wrist symptoms
ICD-10 Codes:
S63591D: Other specified sprain of right wrist, subsequent encounter
What procedures does Dr. Trumble perform?
As an Orthopedic Hand Surgeon, Dr. Trumble performs a variety of medical procedures.
This procedure information is derived from anonymized insurance claims and highlights
the medical procedures most commonly performed by Dr. Trumble. It provides insight
into the doctor’s areas of experience and expertise based on real-world patient encounters
from the past two years, updated quarterly.
Also known as:
Carpal Tunnel Release Surgery (Endoscopic)
Trigger Finger Release Surgery
Hand or Finger Tendon Lengthening
Hand Muscle Release Surgery
Hand or Finger Tendon Shortening
Dupuytren's Contracture Release (Percutaneous)
Dupuytren's Contracture Surgery (Single Finger)
Release of Finger or Palm Tendon
Open Flexor Tendon Release in Palm
Dupuytren's Contracture Surgery (Additional Finger)
Wrist Ganglion Cyst Removal
Finger Extensor Tendon Repair
Wrist Bone Removal
Endoscopy
Endoscopic Carpal Tunnel Surgery
Wrist Endoscopy for Carpal Tunnel
Transverse Carpal Ligament Release
Tendon Sheath Incision
Trigger Finger Tenolysis
Finger Tendon Release
Hand Tendon Surgery
Flexor Tendon Lengthening
Intrinsic Muscle Release
Hand Tendon Release
Muscle Lengthening Hand
Extensor Tendon Shortening (Hand)
Finger Tendon Repair
Tendon Shortening Surgery
Percutaneous Palmar Fasciotomy', 'Needle Aponeurotomy', 'Minimally Invasive Dupuytren's Surgery
26123: Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft);
26440: Tenolysis, flexor tendon; palm OR finger, each tendon
26450: Tenotomy, flexor, palm, open, each tendon
26125: Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft); each additional digit (List separately in addition to code for primary procedure)
25111: Excision of ganglion, wrist (dorsal or volar); primary
26418: Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon
25210: Carpectomy; 1 bone
Also known as:
Complex Finger Tendon Release
Tendon Release in Forearm or Wrist
Tendon Release Surgery for Hand or Finger
Forearm or Wrist Tendon Lengthening/Shortening
Extensor Tendon Tenolysis
Finger Tendon Adhesion Release
Forearm Tendon Surgery
Forearm Tendon Tenolysis
Wrist Tendon Release
Adhesion Removal from Tendon
Extensor tenolysis
Tendon freeing surgery
Hand tendon surgery
Tendon Adjustment Surgery
Flexor Tendon Surgery
Extensor Tendon Surgery
Wrist Tendon Repair
CPT Codes:
26449: Tenolysis, complex, extensor tendon, finger, including forearm, each tendon
25295: Tenolysis, flexor or extensor tendon, forearm and/or wrist, single, each tendon
26445: Tenolysis, extensor tendon, hand OR finger, each tendon
25280: Lengthening or shortening of flexor or extensor tendon, forearm and/or wrist, single, each tendon
Also known as:
Open Wrist Reconstruction for Instability
Wrist Arthroscopy
Wrist Joint Release Surgery
Wrist Tendon Sheath Removal (Synovectomy)
Wrist Tendon Sheath Release
Endoscopy
Wrist Ligament Repair
Carpal Instability Surgery
Wrist Capsulorrhaphy
Tendon Transfer Wrist
Wrist Scope Surgery
Keyhole Wrist Surgery
Wrist Joint Repair
Triangular Fibrocartilage Repair
Wrist Capsulotomy
Wrist Contracture Release
Stiff Wrist Surgery
Extensor Tendon Sheath Synovectomy
Wrist Tendon Lining Removal
Tenosynovitis Surgery Wrist
Inflamed Tendon Sheath Excision
De Quervain's Release
Wrist Tendon Decompression
Extensor Tendon Sheath Incision
CPT Codes:
25320: Capsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis, ligament repair, tendon transfer or graft) (includes synovectomy, capsulotomy and open reduction) for carpal instability
20680: Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)
26320: Removal of implant from finger or hand
Also known as:
Finger Joint Capsule Surgery
Finger Joint Capsulectomy
Finger Joint Capsulotomy
Interphalangeal Joint Surgery
CPT Codes:
26525: Capsulectomy or capsulotomy; interphalangeal joint, each joint
Also known as:
Finger Joint Surgery
Capsulectomy Finger
Capsulotomy Finger Joint
MCP Joint Surgery
Finger Joint Release
CPT Codes:
26520: Capsulectomy or capsulotomy; metacarpophalangeal joint, each joint
Also known as:
Hand or Finger Tendon Lengthening
Extensor tendon lengthening
Finger tendon surgery
Hand tendon release
CPT Codes:
26476: Lengthening of tendon, extensor, hand or finger, each tendon
Also known as:
Wrist or Hand Joint Replacement (Interposition)
Intercarpal Arthroplasty
Carpometacarpal Joint Replacement
Tendon Interposition Arthroplasty
CPT Codes:
25447: Arthroplasty, Intercarpal Or Carpometacarpal Joints; Interposition (Eg, Tendon)
Also known as:
Hand Tendon Transfer
Carpometacarpal Tendon Transplant
Dorsum of Hand Tendon Surgery
Tendon Relocation in Hand
CPT Codes:
26480: Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without free graft, each tendon
Also known as:
Partial Finger Bone Removal
Finger Bone Infection Removal
Distal Phalanx Excision
Finger Bone Debridement
Osteomyelitis Finger Surgery
Finger Tip Bone Removal
Finger Phalanx Bone Excision
Osteomyelitis of Finger Treatment
CPT Codes:
26236: Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); distal phalanx of finger
26235: Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); proximal or middle phalanx of finger
Also known as:
Hand or Finger Cyst Removal
Ganglion cyst removal hand
Tendon sheath lesion excision
Mucous cyst removal finger
CPT Codes:
26160: Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or finger
Also known as:
Thumb Base Joint Replacement
Finger or Toe Joint Replacement
Trapezium arthroplasty
Thumb CMC joint replacement
Basal joint replacement thumb
Finger Joint Arthroplasty
Toe Joint Replacement
Interphalangeal Joint Prosthesis
CPT Codes:
25445: Arthroplasty with prosthetic replacement; trapezium
26536: Arthroplasty, interphalangeal joint; with prosthetic implant, each joint
Also known as:
Finger Joint Ligament Reconstruction
Interphalangeal Ligament Repair
Finger Collateral Ligament Graft
Finger Joint Stabilization Surgery
CPT Codes:
26545: Reconstruction, collateral ligament, interphalangeal joint, single, including graft, each joint
Also known as:
Open Surgery for Wrist Joint Dislocation
Distal Radioulnar Joint Dislocation Repair
Wrist Dislocation Open Reduction
DRUJ Dislocation Surgery
Chronic Wrist Dislocation Treatment
CPT Codes:
25676: Open treatment of distal radioulnar dislocation, acute or chronic
Also known as:
Partial Ulna Bone Removal
Ulna Bone Cut (Osteotomy)
Ulna Bone Excision
Bone Debridement (Ulna)
Osteomyelitis Ulna Surgery
Ulna Osteotomy
Forearm Bone Reshaping
Ulna Shortening/Lengthening
Corrective Ulna Surgery
CPT Codes:
25150: Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); ulna
25360: Osteotomy; ulna
Also known as:
Finger Joint Ligament Repair
Metacarpophalangeal Joint Ligament Reconstruction
MCP Joint Ligament Repair
Knuckle Ligament Surgery
CPT Codes:
26542: Reconstruction, collateral ligament, metacarpophalangeal joint, single; with local tissue (eg, adductor advancement)
Also known as:
Finger Joint Manipulation Under Anesthesia
Anesthesia
Finger Joint Adjustment
Finger Joint Reduction
Finger Joint Mobilization
Anesthetized Finger Manipulation
CPT Codes:
26340: Manipulation, finger joint, under anesthesia, each joint
Also known as:
Wrist Tendon Repair for Finger Movement
Finger flexor tenodesis
Wrist tendon stabilization
Tendon surgery for finger control
CPT Codes:
25300: Tenodesis at wrist; flexors of fingers
Also known as:
Forearm or Wrist Extensor Tendon Sheath Repair with Graft
Wrist Tendon Graft Repair
Extensor Tendon Sheath Reconstruction
Forearm Tendon Repair with Tissue Graft
CPT Codes:
25275: Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)
Also known as:
Open Surgery for Complex Wrist Fracture
Distal Radius Fracture Repair (Open)
Wrist Fracture with Internal Fixation
Complex Radial Fracture Surgery
Epiphyseal Separation Repair (Wrist)
CPT Codes:
25609: Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments
Also known as:
Small Joint or Bursa Injection/Aspiration
Joint Tap
Bursa Fluid Removal
Small Joint Injection
Arthrocentesis
CPT Codes:
20600: Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance
Also known as:
Wrist Joint Stabilization Surgery
Distal Ulna Stabilization
DRUJ Reconstruction
Wrist Tendon Transfer
Unstable Wrist Repair
CPT Codes:
25337: Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint, secondary by soft tissue stabilization (eg, tendon transfer, tendon graft or weave, or tenodesis) with or without open reduction of distal radioulnar joint
Also known as:
Finger or Thumb Tip Fracture Repair
Open Surgery for Finger/Thumb Fracture
Distal Phalanx Fracture Surgery
Finger Bone Break Repair
Open Reduction Internal Fixation (Finger)
Phalangeal Shaft Fracture Repair
Finger Bone Internal Fixation
Broken Finger Surgery
CPT Codes:
26765: Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when performed, each
26735: Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, includes internal fixation, when performed, each
Also known as:
Small Hand or Finger Tumor Removal
Hand Soft Tissue Excision
Finger Vascular Malformation Removal
Intramuscular Tumor Excision
Hand Lump Removal
CPT Codes:
26116: Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); less than 1.5 cm
Also known as:
Finger or Hand Joint Fracture Repair
Open Repair of Hand Bone Fracture (Metacarpal)
Articular Fracture Repair Hand
Metacarpophalangeal Joint Fracture Surgery
Interphalangeal Joint Fracture Repair
Internal Fixation for Hand Fracture
Metacarpal Fracture Surgery
Hand Fracture Fixation
Broken Hand Bone Surgery
Metacarpal Open Reduction Internal Fixation (ORIF)
CPT Codes:
26746: Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includes internal fixation, when performed, each
26615: Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone
Also known as:
Finger Ligament Repair
Collateral ligament repair (finger)
MP joint ligament repair
Finger joint stabilization surgery
CPT Codes:
26540: Repair of collateral ligament, metacarpophalangeal or interphalangeal joint
64450: Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch
Also known as:
Axillary Nerve Block Injection
Armpit nerve block
Axillary nerve pain injection
Shoulder nerve block
Guided nerve injection
CPT Codes:
64417: Injection(s), anesthetic agent(s) and/or steroid; axillary nerve, including imaging guidance, when performed
Also known as:
Carpal Tunnel Release Surgery
Median Nerve Neuroplasty
Carpal Tunnel Decompression
Median Nerve Transposition
CPT Codes:
64721: Neuroplasty and/or transposition; median nerve at carpal tunnel
Also known as:
Major Arm or Leg Nerve Repair
Peripheral Nerve Surgery
Nerve Reconstruction Arm/Leg
Open Neuroplasty
CPT Codes:
64708: Neuroplasty, major peripheral nerve, arm or leg, open; other than specified
Also known as:
Skin Flap Surgery
Tissue Transfer
Local Flap Reconstruction
Adjacent Tissue Rearrangement
CPT Codes:
14040: Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less
Also known as:
Surgical Preparation for Skin Graft (Infants/Children)
Surgery
Wound Debridement for Graft
Burn Scar Release Surgery
Recipient Site Preparation for Skin Repair
CPT Codes:
15004: Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children
Also known as:
Small Skin Flap Surgery (Scalp, Arms, or Legs)
Adjacent Tissue Transfer
Local Flap Surgery
Skin Rearrangement Procedure
Small Defect Skin Repair
CPT Codes:
14020: Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less
Also known as:
Nail Bed Repair
Fingernail Bed Repair
Toenail Bed Repair
Nail Injury Repair
CPT Codes:
11760: Repair of nail bed
Also known as:
Full Thickness Skin Graft (Face, Neck, Hands, Feet)
Facial skin graft
Hand skin graft
Neck skin graft
Genital skin graft
CPT Codes:
15240: Full Thickness Graft, Free, Including Direct Closure Of Donor Site, Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, Hands, And/Or Feet; 20 Sq Cm Or Less
Also known as:
Nail Removal
Nail Plate Avulsion
Toenail Removal
Fingernail Removal
CPT Codes:
11730: Avulsion of nail plate, partial or complete, simple; single
Does Dr. Trumble accept my insurance?
Dr. Trumble accepts most major insurance plans. Important: Please call our office at (425) 999-3580 before your appointment to verify that your specific plan and network are accepted.
What insurance plans does Dr. Trumble accept in Bellevue, WA?
Dr. Trumble in Bellevue, WA accepts plans from many carriers. While this list is updated regularly, it is not a guarantee of coverage.
100% of patients found the doctor and staff friendly and the office clean and modern
Attentiveness
100% of patients felt that their time spent with the doctor was meaningful and impactful and that any follow ups were addressed quickly
Appointment Booking
100% of patients found it easy to book an appointment
Diagnosis
100% of patients were satisfied with the doctor's diagnosis and explanation of their condition
Patients give Dr. Thomas Trumble an Excellent
overall experience rating of 5 out of 5 stars. Dr. Trumble has been rated and reviewed by 1 patient. These ratings are based on a variety of factors, including the amount of time patients spent with Dr. Trumble, his bedside manner, appointment waiting time, friendliness of the office staff, clarity of diagnosis, and more.
What is Dr. Trumble's NPI number?An National Provider Identifier (NPI) is a unique ID number that identifies doctors and healthcare providers nationwide.
Dr. Trumble's National Provider Identifier (NPI) number is 1114003837.
What common questions do patients ask about Dr. Trumble?
Here are answers to patients Frequently Asked Questions (FAQ’s) about Dr. Trumble
What is Dr. Thomas Trumble's specialty?
Dr. Trumble is a Orthopedic Hand Surgeon near Bellevue, WA.
An orthopaedic surgeon specializing in the upper extremity focuses on the investigation, preservation, and restoration of all structures affecting the form and function of the hand and wrist. This specialist employs medical, surgical, and rehabilitative techniques to treat various conditions and injuries related to the upper extremity. Contact Dr. Trumble to book an appointment today.
Is this Dr. Thomas Trumble affiliated with a ranked Castle Connolly Top Hospital?
Yes, Dr. Trumble is affiliated with Overlake Hospital Medical Center, EvergreenHealth Medical Center, Swedish Issaquah Campus, Swedish Cherry Hill Campus, Swedish Edmonds Campus which are a Castle Connolly
Top Hospitals. Castle Connolly Top Hospitals are healthcare institutions recognized for their
excellence in specific medical procedures and overall patient care. They are identified through
a rigorous peer nomination process, evaluating factors like patient outcomes, quality of care, and expertise.
The list recognizes hospitals that excel in 20 or more specific medical procedures, representing the
top 25% nationwide.
Castle Connolly Top Hospitals
Where can I learn more about Orthopedic Hand Surgeon?
Explore Orthopedic Hand Surgeon with insights from trusted medical experts on
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Is Thomas Trumble accepting new patients in Bellevue, WA?
Yes, Dr. Thomas Trumble is accepting new patients at this time.
Does Dr. Thomas Trumble offer online booking?
Please contact Dr. Trumble's office at (425) 999-3580 for information about online booking, telehealth, or to schedule an appointment.
How can I make an appointment with Thomas Trumble?
Please contact Dr. Trumble's office at (425) 999-3580 for information regarding telehealth appointment availability or for scheduling assistance.
Which board certifications does Dr. Thomas Trumble have?
Dr. Thomas Trumble is certified by the American Board of Orthopaedic Surgery.
Dr. Todd Guyette, MD is an Orthopedic Hand Surgeon, who primarily practices in Bellevue, WA with 1 additional practice location. He has been practicing for over 22 years and is board certified.