Provider Demographics
NPI:1093760316
Name:STAMBOR, DANIEL C (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:STAMBOR
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 1:1530 N 115TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8411
Mailing Address - Country:US
Mailing Address - Phone:206-368-1311
Mailing Address - Fax:206-366-0907
Practice Address - Street 1:1530 N 115TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8411
Practice Address - Country:US
Practice Address - Phone:206-368-1311
Practice Address - Fax:206-366-0907
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD37102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAD50373Medicare UPIN
WA1093760316Medicare NSC