Provider Demographics
NPI:1073539573
Name:HABENER, STEPHEN ARTHUR (MD, INC, PS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ARTHUR
Last Name:HABENER
Suffix:
Gender:M
Credentials:MD, INC, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3318
Mailing Address - Country:US
Mailing Address - Phone:360-373-2571
Mailing Address - Fax:360-479-4970
Practice Address - Street 1:2635 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3318
Practice Address - Country:US
Practice Address - Phone:360-373-2571
Practice Address - Fax:360-479-4970
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00011993174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1340306Medicaid
WA91-0965619OtherEIN
WA91-0965619OtherEIN
WAA06927Medicare UPIN