Healthcare Provider Details

I. General information

NPI: 1942273768
Provider Name (Legal Business Name): WILLIAM EDWIN KRIEGSMAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 3RD ST SE SUITE 240
PUYALLUP WA
98372-3771
US

IV. Provider business mailing address

PO BOX 505
OAKVILLE WA
98568-0505
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-1420
  • Fax: 253-697-1439
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00044109
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: