Healthcare Provider Details

I. General information

NPI: 1659335255
Provider Name (Legal Business Name): MAURICE LEE DOERFLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38700 SE RIVER ST
SNOQUALMIE WA
98065
US

IV. Provider business mailing address

PO BOX 2013
SNOQUALMIE WA
98065-2013
US

V. Phone/Fax

Practice location:
  • Phone: 425-888-2299
  • Fax: 425-888-1204
Mailing address:
  • Phone: 425-888-2299
  • Fax: 425-888-1204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number252090013
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: