Basic Information
| Provider Information | |||||||||
| NPI: | 1053307298 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTHONY | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9722342987 | ||||||||
| Practice Location | |||||||||
| Address1: | 309 E FARWELL RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992188202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094642873 | ||||||||
| FaxNumber: | 5094660914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 06/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | OP00001601 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 8226334 | 05 | WA | MEDICAID | 000010143048 | 01 | BLUE SHIELD OF IDAHO | OTHER | 805167400 | 05 | ID | MEDICAID | 83004753 | 01 | TX | RAILROAD MEDICARE | OTHER | 121591 | 01 | WA | LABOR & INDUSTRIES | OTHER | 5337010 | 01 | AETNA | OTHER | AN7110 | 01 | ASURIS NW HEALTH | OTHER | KF781 | 01 | BLUE CROSS OF IDAHO | OTHER |