Provider Demographics
NPI:1568440089
Name:STAMBAUGH, LLOYD EDWIN III (MD)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:EDWIN
Last Name:STAMBAUGH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-123212085R0202X
AKMEDS60782085R0202X
WAMD000400542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0174470OtherLNI-RADIA REST OF WA
ID1568440089Medicaid
WA0385198OtherLNI-SOUTH SOUND IMAGING
WA0175518OtherLNI-EVERGREEN RADIA
WA0381061OtherLNI-RADIA KING COUNTY
WA0205871OtherLNI-SWEDISH RADIA EDMONDS
WA8320285Medicaid
AK1018396Medicaid
WAP00053261Medicare PIN
WA8862874Medicare PIN
AK1018396Medicaid
WAGAB38871Medicare PIN
ID20004582Medicare PIN
WA175518OtherL&I PROVIDER ID
WA8320285Medicaid
WAP00091795Medicare PIN
WAP01247760Medicare PIN