Healthcare Provider Details

I. General information

NPI: 1174581573
Provider Name (Legal Business Name): STEPHEN WILLIAM BRETZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST ER DEPT
RENTON WA
98055-5714
US

IV. Provider business mailing address

8009 S 180TH ST SUITE 103
KENT WA
98032-1042
US

V. Phone/Fax

Practice location:
  • Phone: 425-251-3440
  • Fax:
Mailing address:
  • Phone: 425-656-4255
  • Fax: 425-656-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberA061172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: