Provider Demographics
NPI:1407940737
Name:GOTTLIEB, STEVEN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:GOTTLIEB
Suffix:
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 1:2205 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2437
Mailing Address - Country:US
Mailing Address - Phone:509-469-6305
Mailing Address - Fax:509-575-3398
Practice Address - Street 1:2205 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2437
Practice Address - Country:US
Practice Address - Phone:509-469-6305
Practice Address - Fax:509-575-3398
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030027208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGO5843OtherREGENCE
WA8140923Medicaid
911019392OtherCOMMERCIAL
WA8140923OtherCHPW
22553OtherGROUP HEALTH
GAB15610Medicare ID - Type Unspecified
WAGO5843OtherREGENCE
911019392OtherCOMMERCIAL