Provider Demographics
NPI:1417909649
Name:BEGERT, STEPHEN P (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:BEGERT
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 1:21911 76TH AVE W
Mailing Address - Street 2:#110
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7903
Mailing Address - Country:US
Mailing Address - Phone:425-640-4950
Mailing Address - Fax:425-640-4958
Practice Address - Street 1:21911 76TH AVE W
Practice Address - Street 2:#110
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7903
Practice Address - Country:US
Practice Address - Phone:425-640-4950
Practice Address - Fax:425-640-4958
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0024180174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1090950Medicaid
WAR05391OtherREGENCE BLUE SHIELD
WAR05391OtherREGENCE BLUE SHIELD