Provider Demographics
NPI:1902932247
Name:THORSON, STUART H (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:H
Last Name:THORSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:360-729-1462
Mailing Address - Fax:360-729-3104
Practice Address - Street 1:2980 SQUALICUM PKWY STE 301
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-788-6112
Practice Address - Fax:360-788-6114
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018372207R00000X, 207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8303737Medicaid
WAP00670536OtherRAILROAD MEDICARE
WA1902932247Medicaid
OR221341Medicaid
WA0237220OtherL&I AND CRIME VICTIMS
WA3141THOtherREGENCE
WA4411689OtherAETNA
AKMD0850WMedicaid
ORC91274Medicare UPIN
WA3141THOtherREGENCE
AKMD0850WMedicaid