Provider Demographics
NPI:1669575163
Name:POEHLMANN, DWIGHT SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:SCOTT
Last Name:POEHLMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:34503 9TH AVE S
Mailing Address - Street 2:SUITE 330
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8727
Mailing Address - Country:US
Mailing Address - Phone:253-838-3695
Mailing Address - Fax:253-661-1987
Practice Address - Street 1:34503 9TH AVE S
Practice Address - Street 2:SUITE 330
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8727
Practice Address - Country:US
Practice Address - Phone:253-838-3695
Practice Address - Fax:253-661-1987
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH8332207V00000X, 207VF0040X
WAMD60330578207VF0040X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B4475OtherBCBS OF TEXAS
TX101912704Medicaid
TXF51522Medicare UPIN
TX8D7166Medicare ID - Type Unspecified