Provider Demographics
NPI:1295776029
Name:STOCKBURGER, JOHN SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:STOCKBURGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:709 W ORCHARD DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:3130 SQUALICUM PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1940
Practice Address - Country:US
Practice Address - Phone:360-756-0382
Practice Address - Fax:360-756-5184
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-07-24
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Provider Licenses
StateLicense IDTaxonomies
WAMD00039090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3552STOtherREGENCE BLUESHIELD
WA423898072OtherGROUP HEALTH COOPERATIVE
WA3976STOtherREGENCE BLUESHIELD
WA8901814OtherLABOR & INDUSTRIES (CV)
WA0192819OtherLABOR & INDUSTRIES (REG)
WA8269771Medicaid
WA0192819OtherLABOR & INDUSTRIES (REG)
WAH42367Medicare UPIN