Provider Demographics
NPI:1639139348
Name:STICKNEY, JEFFREY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:STICKNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:206-264-8689
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:H-210
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-823-4000
Practice Address - Fax:425-821-3550
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027879207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB32416Medicare ID - Type Unspecified
WAF28682Medicare UPIN