Healthcare Provider Details

I. General information

NPI: 1851316780
Provider Name (Legal Business Name): STEPHEN E POORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 49TH AVE NE
TACOMA WA
98422-2421
US

IV. Provider business mailing address

4215 49TH AVE NE
TACOMA WA
98422-2421
US

V. Phone/Fax

Practice location:
  • Phone: 253-459-7699
  • Fax:
Mailing address:
  • Phone: 253-459-7699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD00035285
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00035285
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: