Provider Demographics
NPI:1811057680
Name:ANDERSON, STEPHEN BOWEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BOWEN
Last Name:ANDERSON
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 1:1632 116TH AVE NE
Mailing Address - Street 2:STE A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3035
Mailing Address - Country:US
Mailing Address - Phone:425-453-9060
Mailing Address - Fax:
Practice Address - Street 1:1632 116TH AVE NE
Practice Address - Street 2:STE A
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3035
Practice Address - Country:US
Practice Address - Phone:425-453-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
WAANDERSB568KN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist