Provider Demographics
NPI:1083663025
Name:STAMP, DOUGLAS L (PAC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:STAMP
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 CHERRY AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4203
Mailing Address - Country:US
Mailing Address - Phone:360-415-9110
Mailing Address - Fax:360-479-0265
Practice Address - Street 1:2601 CHERRY AVE
Practice Address - Street 2:STE 200
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4203
Practice Address - Country:US
Practice Address - Phone:360-415-9110
Practice Address - Fax:360-479-0265
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0A10000201363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0305750OtherLABOR & INDUSTRIES
WA0305750OtherLABOR & INDUSTRIES
E20264Medicare UPIN