Provider Demographics
NPI:1033479746
Name:STEVEN W. MUSTO, M.D., PLLC
Entity Type:Organization
Organization Name:STEVEN W. MUSTO, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MUSTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-331-6525
Mailing Address - Street 1:5670 94TH PL SW
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-3655
Mailing Address - Country:US
Mailing Address - Phone:360-331-6525
Mailing Address - Fax:
Practice Address - Street 1:1638 E MAIN ST
Practice Address - Street 2:STE 202
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249
Practice Address - Country:US
Practice Address - Phone:360-331-6525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034938207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty