Provider Demographics
NPI:1407997588
Name:AUSTIN, STUART M (PA-C)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:M
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 31ST PL W
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-1323
Mailing Address - Country:US
Mailing Address - Phone:425-267-0299
Mailing Address - Fax:425-513-1446
Practice Address - Street 1:11001 31ST PL W
Practice Address - Street 2:SUITE 1
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-1323
Practice Address - Country:US
Practice Address - Phone:425-267-0299
Practice Address - Fax:425-513-1446
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003609363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA165386OtherLABOR AND INDUSTRIES