Provider Demographics
NPI:1851316780
Name:POORE, STEPHEN E (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:POORE
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 1:4215 49TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-2421
Mailing Address - Country:US
Mailing Address - Phone:253-459-7699
Mailing Address - Fax:
Practice Address - Street 1:4215 49TH AVE NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-2421
Practice Address - Country:US
Practice Address - Phone:253-459-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035285207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160040245OtherRAILROAD MEDICARE
WAPO7788OtherBLUE SHIELD
WA0039592OtherLABOR & INDUSTRY
WAUS1004480OtherAETNA/USHC SPECIALIST
WA8221533Medicaid
160040245OtherRAILROAD MEDICARE
WA000182924Medicare PIN