Provider Demographics
NPI:1477945319
Name:STEFFENSEN, RUSSELL LEE (DO)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:LEE
Last Name:STEFFENSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 169TH ST S
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8201
Mailing Address - Country:US
Mailing Address - Phone:253-538-4660
Mailing Address - Fax:253-538-4675
Practice Address - Street 1:144 169TH ST S
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8201
Practice Address - Country:US
Practice Address - Phone:253-538-4660
Practice Address - Fax:253-538-4675
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61064120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2159487Medicaid