Provider Demographics
NPI:1104045889
Name:STENGEL, JOSEPH WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WAYNE
Last Name:STENGEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 ENSIGN RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5075
Mailing Address - Country:US
Mailing Address - Phone:360-493-4609
Mailing Address - Fax:360-493-4603
Practice Address - Street 1:1108 BASICH BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1066
Practice Address - Country:US
Practice Address - Phone:360-533-0400
Practice Address - Fax:360-599-5633
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP000023382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8513681Medicaid
WA8513681Medicaid