Provider Demographics
NPI:1568513703
Name:ATKINSON, STEPHEN G (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:ATKINSON
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 1:1427 JEFFERSON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3649
Mailing Address - Country:US
Mailing Address - Phone:360-825-2701
Mailing Address - Fax:360-825-5724
Practice Address - Street 1:1427 JEFFERSON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3649
Practice Address - Country:US
Practice Address - Phone:360-825-2701
Practice Address - Fax:360-825-5724
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039844174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7109788Medicaid
WA0155711OtherWA LABOR & INDUSTRIES
WA0155712OtherWA L& I
WA1113398Medicaid
WA5197ATOtherREGENCE BLUE SHIELD
WA0155712OtherWA L& I
WA5197ATOtherREGENCE BLUE SHIELD
WAAB25247Medicare PIN