Provider Demographics
NPI:1619160223
Name:HERTER, CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:
Last Name:HERTER
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:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-332-6948
Mailing Address - Fax:425-304-1102
Practice Address - Street 1:3916 148TH ST SE
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-4751
Practice Address - Country:US
Practice Address - Phone:425-332-6948
Practice Address - Fax:425-304-1102
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA26744207QA0505X
WAMD00026744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8202764Medicaid
WAA95597Medicare UPIN
WA8202764Medicaid
WAG8919317Medicare PIN
WA8875671Medicare PIN
WAG8898769Medicare PIN
WAG8922256Medicare PIN