Provider Demographics
NPI:1861543035
Name:DAVIES, STACY J (MD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:J
Last Name:DAVIES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22216 SE 272ND ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-7420
Mailing Address - Country:US
Mailing Address - Phone:425-413-8864
Mailing Address - Fax:425-413-8865
Practice Address - Street 1:22216 SE 272ND ST
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-7420
Practice Address - Country:US
Practice Address - Phone:425-413-8864
Practice Address - Fax:425-413-8865
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG18983Medicare UPIN