Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OP60856076 | WA |
NPI | 1659798098 |
---|---|
Provider Name | Dr. Benjamin Stumpf |
First Address | Camas, WA 98607-2152 |
Second Address | Camas, WA 98607-2152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2014 |
Last Update Date | 09/08/2019 |