Healthcare Provider Details

I. General information

NPI: 1942243175
Provider Name (Legal Business Name): WILLIAM FREDRICK ROES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15610 89TH ST CT KPN
LAKEBAY WA
98349
US

IV. Provider business mailing address

PO BOX 129
VAUGHN WA
98394-0129
US

V. Phone/Fax

Practice location:
  • Phone: 253-884-9221
  • Fax: 253-884-5523
Mailing address:
  • Phone: 253-884-9221
  • Fax: 253-884-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00017572
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: