Provider Demographics
NPI:1497791230
Name:SUGARMAN, STANLEY M (MD)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:M
Last Name:SUGARMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 NE PARK PLAZA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5899
Mailing Address - Country:US
Mailing Address - Phone:360-254-8025
Mailing Address - Fax:360-254-8618
Practice Address - Street 1:222 NE PARK PLAZA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5899
Practice Address - Country:US
Practice Address - Phone:360-254-8025
Practice Address - Fax:360-254-8618
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA23640174400000X
WAMD00023640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1013796Medicaid
WA110047161OtherRAILROAD MEDICARE
WAA08099Medicare UPIN
WA1013796Medicaid