Provider Demographics
NPI:1639465420
Name:SOETAERT, DANIEL J (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:SOETAERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:742 LEBO BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3325
Mailing Address - Country:US
Mailing Address - Phone:360-744-4950
Mailing Address - Fax:253-572-1071
Practice Address - Street 1:742 LEBO BLVD STE A
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3325
Practice Address - Country:US
Practice Address - Phone:360-744-4950
Practice Address - Fax:253-572-1071
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60563888208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2046384Medicaid