Provider Demographics
NPI:1386638815
Name:STOKAN, THERESE JEAN (DO)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:JEAN
Last Name:STOKAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:
Other - Last Name:STOKAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-3335
Mailing Address - Fax:206-764-0489
Practice Address - Street 1:3010 STATE ROUTE 109
Practice Address - Street 2:
Practice Address - City:COPALIS BEACH
Practice Address - State:WA
Practice Address - Zip Code:98535-0339
Practice Address - Country:US
Practice Address - Phone:360-289-2427
Practice Address - Fax:360-289-9982
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004207S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
311155352OtherEMERALD HEALTH
OH000000311896OtherANTHEM
0112540OtherUNITED HEALTHCARE
311155352OtherAETNA
OH2453698Medicaid
311155352OtherTRICARE
311155352OtherCIGNA/GENERAL
311155352OtherE V BENEFITS
311155352OtherCENTRAL BENEFITS
OH19557120300OtherBUREAU OF WORKERS COMP
OH311155352OtherOHIO HEALTH CHOICE
311155352OtherPPO NEXT
311155352OtherGREAT WEST
311155352OtherNATIONWIDE INS.
311155352OtherEMERALD HEALTH
OHST4119333Medicare ID - Type UnspecifiedMCARTHUR OHIO OFFICE
311155352OtherNATIONWIDE INS.
311155352OtherE V BENEFITS
OHST4119332Medicare ID - Type UnspecifiedCHILLICOTHE OHIO OFFICE