Provider Demographics
NPI:1437130143
Name:STUPFEL, JAMES THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:STUPFEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 UNANDER AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-1136
Mailing Address - Country:US
Mailing Address - Phone:360-695-0150
Mailing Address - Fax:
Practice Address - Street 1:11808 NE FOURTH PLAIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-5524
Practice Address - Country:US
Practice Address - Phone:360-256-9827
Practice Address - Fax:360-256-9547
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004826363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant