Provider Demographics
NPI:1659374114
Name:KRIEBEL, STEPHEN H (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:H
Last Name:KRIEBEL
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 455
Mailing Address - Street 2:
Mailing Address - City:FORKS
Mailing Address - State:WA
Mailing Address - Zip Code:98331-0455
Mailing Address - Country:US
Mailing Address - Phone:360-374-6224
Mailing Address - Fax:360-374-6039
Practice Address - Street 1:461 G ST
Practice Address - Street 2:
Practice Address - City:FORKS
Practice Address - State:WA
Practice Address - Zip Code:98331-9025
Practice Address - Country:US
Practice Address - Phone:360-374-6224
Practice Address - Fax:360-374-6039
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA13422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0048001OtherL&I
WA1245375518OtherCLINIC NPI
WA1770509242OtherLAURA NPI
WA942707241OtherTAX ID
WA7020654Medicaid
WA7058829Medicaid
WA8156200Medicaid
WAA15708Medicare UPIN
WA942707241OtherTAX ID
WAG000500083Medicare ID - Type UnspecifiedOLD MCARE #