Basic Information
| Provider Information | |||||||||
| NPI: | 1710977764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANG | ||||||||
| FirstName: | HOWARD | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 309 E FARWELL RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992188202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094642873 | ||||||||
| FaxNumber: | 5094660914 | ||||||||
| Practice Location | |||||||||
| Address1: | 309 E FARWELL RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992182225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094642873 | ||||||||
| FaxNumber: | 5094660914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 09/25/2012 | ||||||||
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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 | 207RX0202X | MD00020536 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1019702 | 05 | WA | MEDICAID | 37316 | 01 | WA | LABOR & INDUSTRIES | OTHER | K4778 | 01 | BLUE CROSS OF IDAHO | OTHER | 900000017 | 01 | RAILROAD MEDICARE | OTHER | 00010008977 | 01 | BLUE SHIELD OF IDAHO | OTHER | 4598ST | 01 | ASURIS NW HEALTH | OTHER | 003217400 | 05 | ID | MEDICAID | 4021101 | 01 | AETNA | OTHER |