Organization
EVERGREEN RADIA LLC
Active
Other names
Evergreen Radia
Organization subpart
No
Provider details
NPI number
Authorized official
LLOYD STAMBAUGH MD (PRESIDENT)
(425) 563-1500
Entity
Organization
Contact information
Practice address
11521 NE 128TH ST, SUITE 200, KIRKLAND, WA 98034-4317
(425) 952-6100
(425) 952-6150
Mailing address
19020 33RD AVE W STE 210, LYNNWOOD, WA 98036-4748
(425) 563-1500
(425) 563-1501
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
602317167
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
175238
GROUP LABOR & INDUSTRIES
WA
05
—
7118227
—
WA
01
—
8933574
GROUP CRIME VICTIMS
WA
Enumeration date
09/28/2005
Last updated
09/12/2018
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