Provider Demographics
NPI:1316231962
Name:STEPHENSON, ADAM M (DO)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:M
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:7203 129TH AVE SE
Practice Address - Street 2:STE 100
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98056-1412
Practice Address - Country:US
Practice Address - Phone:425-690-3455
Practice Address - Fax:425-690-9455
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP60384411208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2020726Medicaid
WAG8930792OtherMEDICARE W VALLEY MEDICAL GROUP - RENTON