Individual
KITTREDGE ALEXANDER BALDWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2011 NW MYHRE PL, SILVERDALE, WA 98383-8561
(360) 830-1706
(360) 830-1780
Mailing address
9621 RIDGETOP BLVD NW, SILVERDALE, WA 98383-8502
(360) 830-1706
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
OP00001740
WA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
OP00001740
WA
207RP1001X
Pulmonary Disease Physician
Primary
OP00001740
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
158446
LABOR & INDUSTRIES
WA
01
—
290014550
RAILROAD MEDICARE
—
01
—
7352369
AETNA
—
05
—
8297046
—
WA
01
—
9617BA
REGENCE BLUESHIELD
—
Enumeration date
05/05/2006
Last updated
03/07/2023
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