Provider Demographics
NPI:1003929423
Name:LITCHFIELD, STEPHEN G (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:G
Last Name:LITCHFIELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:210 S 11TH AVE
Mailing Address - Street 2:SUITE 44
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3293
Mailing Address - Country:US
Mailing Address - Phone:509-248-4586
Mailing Address - Fax:509-576-8857
Practice Address - Street 1:210 S 11TH AVE
Practice Address - Street 2:SUITE 44
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3293
Practice Address - Country:US
Practice Address - Phone:509-248-4586
Practice Address - Fax:509-576-8857
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA40208000OtherLABOR & INDUSTRIES
WA600400144001OtherUBI
WA1434208Medicaid
WA035099OtherAOA