Provider Demographics
NPI:1922042852
Name:HILDEBRAND, PAUL W (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:HILDEBRAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 S 336TH STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:800-336-8614
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:11315 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3004
Practice Address - Country:US
Practice Address - Phone:253-589-8700
Practice Address - Fax:253-581-6588
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00022755207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0171937OtherLIWA
WA0171938OtherLIWA
WA2164HIOtherBSWA
WA8207250Medicaid
WA1186HIOtherBSWA
WA1186HIOtherBSWA
WA0171938OtherLIWA
WAG8852746Medicare PIN