Provider Demographics
NPI:1992750954
Name:BENDER, DAVID M (PA C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:BENDER
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S 336TH STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:1415 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4126
Practice Address - Country:US
Practice Address - Phone:360-428-2166
Practice Address - Fax:360-428-2457
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003573363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0223849OtherLIWA
WA8323933Medicaid
WAG8867785Medicare PIN
WAP09136Medicare UPIN
WAGAB24651Medicare PIN