Provider Demographics
NPI:1861532764
Name:EPPEL, DIETER R (DO)
Entity type:Individual
Prefix:
First Name:DIETER
Middle Name:R
Last Name:EPPEL
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 1:222 STATE AVE N
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4544
Mailing Address - Country:US
Mailing Address - Phone:253-372-7788
Mailing Address - Fax:
Practice Address - Street 1:222 STATE AVE N
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4544
Practice Address - Country:US
Practice Address - Phone:253-372-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212286207P00000X
WAOP00002224207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1881323Medicaid
WA8511263Medicaid
NY1881323Medicaid
G8873395Medicare PIN
G8873395Medicare PIN