Provider Demographics
NPI:1932429974
Name:STUART, DAVID H (ABCO/BOCO/LO)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:H
Last Name:STUART
Suffix:
Gender:M
Credentials:ABCO/BOCO/LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 3RD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3268
Mailing Address - Country:US
Mailing Address - Phone:360-577-3505
Mailing Address - Fax:360-577-3509
Practice Address - Street 1:1555 3RD AVE STE B
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3268
Practice Address - Country:US
Practice Address - Phone:360-577-3505
Practice Address - Fax:360-577-3509
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI00000118222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1041842Medicaid