Provider Demographics
NPI:1437183142
Name:VOEGTLEN, RUSSELL BARNES JR (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:BARNES
Last Name:VOEGTLEN
Suffix:JR
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 1:9951 MICKELBERRY RD NW STE 101
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8309
Mailing Address - Country:US
Mailing Address - Phone:360-692-9362
Mailing Address - Fax:360-692-6214
Practice Address - Street 1:9951 MICKELBERRY RD NW STE 101
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8309
Practice Address - Country:US
Practice Address - Phone:360-692-9362
Practice Address - Fax:360-692-6214
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017551208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00017551OtherWA MEDICAL LICENSE
WA1491000Medicaid
AV8757710OtherDEA
F25874Medicare UPIN
WAMD00017551OtherWA MEDICAL LICENSE