Healthcare Provider Details

I. General information

NPI: 1992750954
Provider Name (Legal Business Name): DAVID M BENDER PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 E KINCAID ST
MT VERNON WA
98273-4126
US

IV. Provider business mailing address

505 S 336TH STREET SUITE 600
FEDERAL WAY WA
98003-6328
US

V. Phone/Fax

Practice location:
  • Phone: 360-428-2166
  • Fax: 360-428-2457
Mailing address:
  • Phone: 253-838-6180
  • Fax: 253-838-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10003573
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: