Basic Information
| Provider Information | |||||||||
| NPI: | 1497791230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUGARMAN | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 NE PARK PLAZA DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986845899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602548025 | ||||||||
| FaxNumber: | 3602548618 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 NE PARK PLAZA DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986845899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602548025 | ||||||||
| FaxNumber: | 3602548618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 07/18/2008 | ||||||||
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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 | 174400000X | 23640 | WA | N | Other Service Providers | Specialist | 207R00000X | MD00023640 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1013796 | 05 | WA | MEDICAID | 110047161 | 01 | WA | RAILROAD MEDICARE | OTHER |