Healthcare Provider Details

I. General information

NPI: 1659374114
Provider Name (Legal Business Name): STEPHEN H KRIEBEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 G ST
FORKS WA
98331-9025
US

IV. Provider business mailing address

PO BOX 455
FORKS WA
98331-0455
US

V. Phone/Fax

Practice location:
  • Phone: 360-374-6224
  • Fax: 360-374-6039
Mailing address:
  • Phone: 360-374-6224
  • Fax: 360-374-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13422
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: