Provider Demographics
NPI:1710932934
Name:EPPEL, DIETER (DO)
Entity Type:Individual
Prefix:
First Name:DIETER
Middle Name:
Last Name:EPPEL
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 1:5629 PERDEMCO AVE SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-7807
Mailing Address - Country:US
Mailing Address - Phone:253-509-4717
Mailing Address - Fax:
Practice Address - Street 1:1950 POTTERY AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2592
Practice Address - Country:US
Practice Address - Phone:360-876-5440
Practice Address - Fax:360-876-0718
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1977207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine