Provider Demographics
NPI:1225354152
Name:GOEPFERT, TERESA LYNN (D O)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:GOEPFERT
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 NW MARKET ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3987
Mailing Address - Country:US
Mailing Address - Phone:206-781-6161
Mailing Address - Fax:206-781-6208
Practice Address - Street 1:1801 NW MARKET ST
Practice Address - Street 2:207
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3987
Practice Address - Country:US
Practice Address - Phone:206-781-6161
Practice Address - Fax:206-781-6208
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.123752207V00000X
WAOP60125015207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology