Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 0101267700 | VA |
NPI | 1033614763 |
---|---|
Provider Name | Jon Stockton |
First Address | Silverdale, WA 98315-7102 |
Second Address | Silverdale, WA 98315-7102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2018 |
Last Update Date | 23/01/2021 |