Basic Information
| Provider Information | |||||||||
| NPI: | 1245222173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPRINGATE | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2520 CHERRY AVE | ||||||||
| Address2: | S CHARLES SPRINGATE MD | ||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983104229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604758545 | ||||||||
| FaxNumber: | 3604758542 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 CHERRY AVE | ||||||||
| Address2: | S CHARLES SPRINGATE MD | ||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983104229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604758545 | ||||||||
| FaxNumber: | 3604758542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 05/12/2014 | ||||||||
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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 | 2085R0001X | MD00028700 | WA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1072636 | 05 | WA | MEDICAID | 920000322 | 01 | WA | RR MEDICARE | OTHER |