Provider Demographics
NPI:1518134964
Name:FOGLESONG STABILE, JILLIAN RAE (MD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:RAE
Last Name:FOGLESONG STABILE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:905 EAST D STREET
Mailing Address - Street 2:PO BOX 340
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006
Mailing Address - Country:US
Mailing Address - Phone:509-276-5005
Mailing Address - Fax:509-276-7785
Practice Address - Street 1:905 EAST D STREET
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006
Practice Address - Country:US
Practice Address - Phone:509-276-5005
Practice Address - Fax:509-276-7785
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML 60088576207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8916557Medicare UPIN
WAG8916081Medicare UPIN