Healthcare Provider Details

I. General information

NPI: 1669575163
Provider Name (Legal Business Name): DWIGHT SCOTT POEHLMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34503 9TH AVE S SUITE 330
FEDERAL WAY WA
98003-8727
US

IV. Provider business mailing address

34503 9TH AVE S SUITE 330
FEDERAL WAY WA
98003-8727
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-3695
  • Fax: 253-661-1987
Mailing address:
  • Phone: 253-838-3695
  • Fax: 253-661-1987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberH8332
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD60330578
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberH8332
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60330578
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: