Healthcare Provider Details

I. General information

NPI: 1831280684
Provider Name (Legal Business Name): H. MARTIN VATHEUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HANS MARTIN VATHEUER MD

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37624 SE FURY ST STE 101
SNOQUALMIE WA
98065-9680
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 425-888-2016
  • Fax: 206-320-5170
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00038990
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: