1508854696 NPI number — DR. RICHARD E STEIN M.D.

Table of content: DR. RICHARD E STEIN M.D. (NPI 1508854696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508854696 NPI number — DR. RICHARD E STEIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEIN
Provider First Name:
RICHARD
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1508854696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16122 8TH AVE SW
Provider Second Line Business Mailing Address:
SUITE E3
Provider Business Mailing Address City Name:
BURIEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98166-2967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-431-9771
Provider Business Mailing Address Fax Number:
206-431-5484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16122 8TH AVE SW
Provider Second Line Business Practice Location Address:
SUITE E3
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-2967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-431-9771
Provider Business Practice Location Address Fax Number:
206-431-5484
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  MD00024018 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7094170 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ST3456 . This is a "REGENCE PROV #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1039882 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0131326 . This is a "GRP L&I #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 08315 . This is a "IND L&I #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2218089 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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