Provider Demographics
NPI:1275538563
Name:TEMPLE, EDWARD H (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:TEMPLE
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 1:5908 BEDFORD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-6605
Mailing Address - Country:US
Mailing Address - Phone:509-547-4724
Mailing Address - Fax:509-547-2056
Practice Address - Street 1:5908 BEDFORD ST
Practice Address - Street 2:SUITE C
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-6605
Practice Address - Country:US
Practice Address - Phone:509-547-4724
Practice Address - Fax:509-547-2056
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA18173207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1110022Medicaid
WA160051257OtherMEDICARE RAILRAOD
GAB39974Medicare Oscar/Certification
WAAB14126Medicare ID - Type Unspecified
WA1110022Medicaid