Provider Demographics
NPI:1205842465
Name:CARDON, STUART B (DPM)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:B
Last Name:CARDON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 RACQUET LN
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6109
Mailing Address - Country:US
Mailing Address - Phone:509-225-3668
Mailing Address - Fax:509-225-3448
Practice Address - Street 1:2400 RACQUET LN
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6109
Practice Address - Country:US
Practice Address - Phone:509-225-3668
Practice Address - Fax:509-225-3448
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000565213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8440885Medicaid
WAG8862774Medicare UPIN