Provider Demographics
NPI:1467781344
Name:STOLZOFF, RUSSELL EDAN (LMT)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:EDAN
Last Name:STOLZOFF
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 LAKEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-2517
Mailing Address - Country:US
Mailing Address - Phone:360-671-0546
Mailing Address - Fax:
Practice Address - Street 1:1209 11TH ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7078
Practice Address - Country:US
Practice Address - Phone:360-671-0546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014127174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist