Provider Demographics
NPI:1700979366
Name:STEVEN D WASHBURN PC
Entity type:Organization
Organization Name:STEVEN D WASHBURN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-537-8777
Mailing Address - Street 1:4830 HIGHWAY 260
Mailing Address - Street 2:STE 103
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5845
Mailing Address - Country:US
Mailing Address - Phone:928-537-8777
Mailing Address - Fax:928-537-1914
Practice Address - Street 1:4830 HIGHWAY 260
Practice Address - Street 2:STE 103
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5845
Practice Address - Country:US
Practice Address - Phone:928-537-8777
Practice Address - Fax:928-537-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25791174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ109178Medicare ID - Type UnspecifiedGROUP
1200960001Medicare NSC
AZ1200960001Medicare NSC