Provider Demographics
NPI:1245277938
Name:LAUGHLIN, STEPHEN M (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:LAUGHLIN
Suffix:
Gender:M
Credentials:PA-C
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 340
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-0340
Mailing Address - Country:US
Mailing Address - Phone:509-262-9000
Mailing Address - Fax:509-276-3034
Practice Address - Street 1:702 S PARK ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-7025
Practice Address - Country:US
Practice Address - Phone:509-262-9000
Practice Address - Fax:509-276-3034
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004843363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0197738OtherLABOR & INDUSTRIES
WA8430159Medicaid
WAP87454Medicare UPIN
WAG8853968Medicare PIN