Provider Demographics
NPI:1073528766
Name:BORISH, STANLEY D (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:D
Last Name:BORISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19526 64TH W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5100
Mailing Address - Country:US
Mailing Address - Phone:425-774-1685
Mailing Address - Fax:425-670-0713
Practice Address - Street 1:19526 64TH W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5100
Practice Address - Country:US
Practice Address - Phone:425-774-1685
Practice Address - Fax:425-670-0713
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1022177Medicaid
WAR59249OtherREGENCE BLUE SHIELD
WAA09261Medicare UPIN
WA1200936Medicare ID - Type Unspecified