Provider Demographics
NPI:1376369033
Name:HATCH, LOUIS BOWMAN IV
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:BOWMAN
Last Name:HATCH
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12240 CHINOOK DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-2643
Mailing Address - Country:US
Mailing Address - Phone:360-708-9996
Mailing Address - Fax:
Practice Address - Street 1:1905 CONTINENTAL PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5633
Practice Address - Country:US
Practice Address - Phone:360-755-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist