1144559808 NPI number — DR. DONALD EUGENE BAUERMEISTER MD

Table of content: DR. DONALD EUGENE BAUERMEISTER MD (NPI 1144559808)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144559808 NPI number — DR. DONALD EUGENE BAUERMEISTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUERMEISTER
Provider First Name:
DONALD
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144559808
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 16TH AVENUE EAST
Provider Second Line Business Mailing Address:
CNTRL MED CTR SOUTH
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98112-5211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-241-7195
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6825 216TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-7379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-712-8020
Provider Business Practice Location Address Fax Number:
425-712-8349
Provider Enumeration Date:
12/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  MD00010808 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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