Individual
DR. STANLEY S IP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
34509 9TH AVE S, SUITE 208, FEDERAL WAY, WA 98003-6700
(253) 944-3278
(253) 944-4345
Mailing address
34509 9TH AVE S, SUITE 208, FEDERAL WAY, WA 98003-6700
(253) 944-3278
(253) 944-4345
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
24910
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0246073
STATE L&I
WA
01
—
0246083
STATE L&I
WA
05
—
1029669
—
WA
01
—
W002272
TRICARE
—
Enumeration date
03/19/2007
Last updated
05/13/2011
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