Provider Demographics
NPI:1083658074
Name:SCHREIBER, ELLEN S (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:S
Last Name:SCHREIBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 MEMORIAL ST
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1524
Mailing Address - Country:US
Mailing Address - Phone:509-786-2222
Mailing Address - Fax:509-786-6612
Practice Address - Street 1:723 MEMORIAL ST
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-1524
Practice Address - Country:US
Practice Address - Phone:509-786-2222
Practice Address - Fax:509-786-6612
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041580207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7118334Medicaid
WA8361164Medicaid
WA0165690OtherLABOR AND INDUSTRIES #
WA501312Medicare ID - Type UnspecifiedPMH MEDICARE PROVIDER #
WA0165690OtherLABOR AND INDUSTRIES #
WA8857794Medicare ID - Type UnspecifiedMEDICARE PROVIDER #