Provider Demographics
NPI:1417048752
Name:PEHLKE, DONALD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MICHAEL
Last Name:PEHLKE
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 1:1111 W SPRUCE ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3257
Mailing Address - Country:US
Mailing Address - Phone:509-575-6888
Mailing Address - Fax:509-575-0455
Practice Address - Street 1:1111 W SPRUCE
Practice Address - Street 2:SUITE 24
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-575-6888
Practice Address - Fax:509-575-0455
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA252090015294207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA325247325247OtherPREMERA BC
WAG000119279Medicare ID - Type Unspecified
WA325247325247OtherPREMERA BC