Basic Information
| Provider Information | |||||||||
| NPI: | 1891182259 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | STAMM | ||||||||
| FirstName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9621 RIDGETOP BLVD NW APT 5 | ||||||||
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| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983838502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607823200 | ||||||||
| FaxNumber: | 3607823244 | ||||||||
| Practice Location | |||||||||
| Address1: | 9398 RIDGETOP BLVD NW | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983838505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607823200 | ||||||||
| FaxNumber: | 3607823293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2015 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | ML60559479 | WA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208800000X | MD61030907 | WA | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.