Provider Demographics
NPI:1093808313
Name:STIEFEL, JOY (DO)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:STIEFEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 SE 36TH ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1657
Mailing Address - Country:US
Mailing Address - Phone:425-644-3066
Mailing Address - Fax:425-644-3057
Practice Address - Street 1:14100 SE 36TH ST
Practice Address - Street 2:SUITE 115
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1657
Practice Address - Country:US
Practice Address - Phone:425-644-3066
Practice Address - Fax:425-644-3057
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0193109OtherLABOR & INDUSTRY NUMBER
WA1125897Medicaid
WA9584STOtherREGENCE RIDER NUMBER
WA8850881Medicare ID - Type UnspecifiedMEDICARE NUMBER
WA1125897Medicaid