Provider Demographics
NPI:1134137748
Name:DEGENFELDER, PAUL S (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:DEGENFELDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 5TH ST SE
Mailing Address - Street 2:STE 4200
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4602
Mailing Address - Country:US
Mailing Address - Phone:253-697-3450
Mailing Address - Fax:
Practice Address - Street 1:1450 5TH ST SE
Practice Address - Street 2:STE 4200
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4602
Practice Address - Country:US
Practice Address - Phone:253-697-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045211207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0241995OtherL&I
WA8430787Medicaid
WA8430787Medicaid
WA0241995OtherL&I
G8854941Medicare PIN