Provider Demographics
NPI:1750571238
Name:STUPSKI, BERNARD A (DO)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:A
Last Name:STUPSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 DELAWARE LN
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1408
Mailing Address - Country:US
Mailing Address - Phone:360-566-4402
Mailing Address - Fax:360-566-4403
Practice Address - Street 1:14508 NE 20TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6424
Practice Address - Country:US
Practice Address - Phone:360-852-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60178352207Q00000X
GUDO0028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2009451Medicaid