Provider Demographics
NPI:1134211584
Name:STIEBER, DAVID M (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:STIEBER
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:PO BOX 24071
Mailing Address - Street 2:MS: 314071
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0071
Mailing Address - Country:US
Mailing Address - Phone:907-374-0432
Mailing Address - Fax:907-374-9932
Practice Address - Street 1:1626 30TH AVENUE STE 204
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7423
Practice Address - Country:US
Practice Address - Phone:907-374-0432
Practice Address - Fax:907-374-9932
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39762207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G397620OtherBLUE SHIELD
CA00G397620Medicaid
CAG39762Medicare ID - Type Unspecified