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1851316780

NPI Code Detail

MEDICARE: STEPHEN E POORE MD

MEDICARE: STEPHEN E POORE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	MD00035285	WA
2	207V00000X	Obstetrics & Gynecology Physician	MD00035285	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	160040245	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	PO7788	OTHER	WA	BLUE SHIELD
3	0039592	OTHER	WA	LABOR & INDUSTRY
4	US1004480	OTHER	WA	AETNA/USHC SPECIALIST
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851316780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN E POORE MD

Provider Business Mailing Address
First Line	:	4215 49TH AVE NE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98422-2421
Country	:	US
Telephone Number	:	253-459-7699
Fax Number	:

Provider Business Practice Location Address
First Line	:	4215 49TH AVE NE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98422-2421
Country	:	US
Telephone Number	:	253-459-7699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	01/10/2020

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9040 JACKSON AVE
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Directions to “ STEPHEN E POORE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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