Provider Demographics
NPI:1629485701
Name:KRETCHMAR, JOSHUA B (DO)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:B
Last Name:KRETCHMAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 GLENDALE DR W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-2200
Mailing Address - Country:US
Mailing Address - Phone:206-407-4171
Mailing Address - Fax:817-440-7378
Practice Address - Street 1:1314 CENTRAL AVE S STE 103
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-7430
Practice Address - Country:US
Practice Address - Phone:817-789-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 13841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine