Provider Demographics
NPI:1245577675
Name:STAPLES, JOHN ADAM (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ADAM
Last Name:STAPLES
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 1:1002 - 1025 GILFORD ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:BC
Mailing Address - Zip Code:V6G2P2
Mailing Address - Country:CA
Mailing Address - Phone:604-868-6875
Mailing Address - Fax:
Practice Address - Street 1:1081 BURRARD ST
Practice Address - Street 2:ROOM 5910B
Practice Address - City:VANCOUVER
Practice Address - State:BC
Practice Address - Zip Code:V6Z1Y6
Practice Address - Country:CA
Practice Address - Phone:604-682-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60305892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1245577675Medicaid