Healthcare Provider Details

I. General information

NPI: 1982050779
Provider Name (Legal Business Name): LEAH G KOBES-JURGENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E J ST STE 2B
DEER PARK WA
99006-8500
US

IV. Provider business mailing address

20 E J ST STE 2B
DEER PARK WA
99006-8500
US

V. Phone/Fax

Practice location:
  • Phone: 509-276-8012
  • Fax: 509-276-8350
Mailing address:
  • Phone: 509-276-8012
  • Fax: 509-276-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60888534
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: