Provider Demographics
NPI:1134279359
Name:KEVIN P. SCHOENFELDER, MD PS
Entity type:Organization
Organization Name:KEVIN P. SCHOENFELDER, MD PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-272-0186
Mailing Address - Street 1:1515 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3933
Mailing Address - Country:US
Mailing Address - Phone:253-272-0186
Mailing Address - Fax:253-272-6242
Practice Address - Street 1:1515 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3933
Practice Address - Country:US
Practice Address - Phone:253-272-0186
Practice Address - Fax:253-272-6242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10000836363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA127908OtherWORKERS COMP
WACO1073OtherREGENCE BLUE SHIELD
WAR31590Medicare UPIN
WA127908OtherWORKERS COMP