Provider Demographics
NPI:1639153232
Name:EHRET, FREDERICK W (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:W
Last Name:EHRET
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 1:2202 S CEDAR ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2318
Mailing Address - Country:US
Mailing Address - Phone:253-627-2900
Mailing Address - Fax:253-627-2941
Practice Address - Street 1:2202 S CEDAR ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2318
Practice Address - Country:US
Practice Address - Phone:253-627-2900
Practice Address - Fax:253-627-2941
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000385882086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8263287Medicaid
WA155547OtherDEPT OF LABOR & INDUSTRY
WA155547OtherDEPT OF LABOR & INDUSTRY
WA8263287Medicaid