Provider Demographics
NPI:1942297353
Name:SCHERBARTH, KENNETH CJ (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:CJ
Last Name:SCHERBARTH
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 1:1802 S UNION AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1947
Mailing Address - Country:US
Mailing Address - Phone:253-752-6965
Mailing Address - Fax:253-759-6056
Practice Address - Street 1:1802 S UNION AVE
Practice Address - Street 2:STE 200
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1947
Practice Address - Country:US
Practice Address - Phone:253-752-6965
Practice Address - Fax:253-759-6056
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00000899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WASC4440OtherREGENCE BCBS
WA17661OtherLABOR & INDUSTRIES
WA1757202Medicaid
WASC4440OtherREGENCE BCBS