1902932247 NPI number — STUART H THORSON M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902932247 NPI number — STUART H THORSON M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

THORSON

Provider First Name:

STUART

Provider Middle Name:

H

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1902932247

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/05/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1115 SE 164TH AVE DEPT 358

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

VANCOUVER

Provider Business Mailing Address State Name:

WA

Provider Business Mailing Address Postal Code:

98683-8004

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

360-729-1462

Provider Business Mailing Address Fax Number:

360-729-3104

Provider First Line Business Practice Location Address:

2980 SQUALICUM PKWY STE 301

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BELLINGHAM

Provider Business Practice Location Address State Name:

WA

Provider Business Practice Location Address Postal Code:

98225

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

360-788-6112

Provider Business Practice Location Address Fax Number:

360-788-6114

Provider Enumeration Date:

02/23/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  MD00018372 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RC0200X , with the licence number: MD00018372 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RS0012X , with the licence number: MD00018372 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RP1001X , with the licence number: MD00018372 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 8303737 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
• Identifier: P00670536 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 1902932247 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
• Identifier: 221341 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
• Identifier: 0237220 . This is a "L&I AND CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 3141TH . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: 4411689 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: MD0850W , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".