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Individual

JONATHAN H STAVER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
400 S 43RD ST, RENTON, WA 98055-5714
(800) 540-1814
Mailing address
PO BOX 84571, SEATTLE, WA 98124-5871
(425) 407-1500
(425) 407-1112

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD60077497
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0248910
L&I
WA
05
1992849574
WA
Enumeration date
02/16/2007
Last updated
08/17/2010
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