Healthcare Provider Details

I. General information

NPI: 1093732182
Provider Name (Legal Business Name): KURT E FRAUENPREIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 SOUTH THIRD STREET
DAYTON WA
99328
US

IV. Provider business mailing address

1012 SOUTH THIRD STREET
DAYTON WA
99328
US

V. Phone/Fax

Practice location:
  • Phone: 509-382-3200
  • Fax: 509-382-2748
Mailing address:
  • Phone: 509-382-3200
  • Fax: 509-382-2748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60578593
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD60578593
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: