Provider Demographics
NPI:1831280684
Name:VATHEUER, H. MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:H.
Middle Name:MARTIN
Last Name:VATHEUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HANS
Other - Middle Name:MARTIN
Other - Last Name:VATHEUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:37624 SE FURY ST STE 101
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9680
Practice Address - Country:US
Practice Address - Phone:425-888-2016
Practice Address - Fax:206-320-5170
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8279036Medicaid
WAG8890250Medicare PIN
WAH38573Medicare UPIN
WA8279036Medicaid
WAG8893454Medicare PIN
WAG8893455Medicare PIN
WAG8878180Medicare PIN
WAGAB22299Medicare PIN