Provider Demographics
NPI:1316045404
Name:NEWELL, STANLEY GENE (DPM)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:GENE
Last Name:NEWELL
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 1:9501 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2108
Mailing Address - Country:US
Mailing Address - Phone:206-527-9160
Mailing Address - Fax:206-527-2850
Practice Address - Street 1:9501 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2108
Practice Address - Country:US
Practice Address - Phone:206-527-9160
Practice Address - Fax:206-527-2850
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO0000151213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1629005Medicaid
T01752Medicare UPIN
WAGAB38455Medicare ID - Type Unspecified