Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD00021577 | WA |
NPI | 1073609509 |
---|---|
Provider Name | Dr. Larry D. Stonesifer |
First Address | Federal Way, WA 98003-8708 |
Second Address | Federal Way, WA 98003-8708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1258805 | (05) | WA |
A08618 | (02) | WA |