Provider Demographics
NPI:1275971822
Name:GOERTZEN, EUGENE WILBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:WILBERT
Last Name:GOERTZEN
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 1:1217 TREEMONT WAY SE
Mailing Address - Street 2:
Mailing Address - City:FALL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:98024-7425
Mailing Address - Country:US
Mailing Address - Phone:425-222-7605
Mailing Address - Fax:510-443-1856
Practice Address - Street 1:1217 TREEMONT WAY SE
Practice Address - Street 2:
Practice Address - City:FALL CITY
Practice Address - State:WA
Practice Address - Zip Code:98024-7425
Practice Address - Country:US
Practice Address - Phone:425-222-7605
Practice Address - Fax:510-443-1856
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00010199208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery