Provider Demographics
NPI:1215939905
Name:SCHOSTAL, CLIFFORD J (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:J
Last Name:SCHOSTAL
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:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-7154
Mailing Address - Country:US
Mailing Address - Phone:360-414-2048
Mailing Address - Fax:360-575-6749
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2310
Practice Address - Country:US
Practice Address - Phone:360-636-4814
Practice Address - Fax:360-414-7965
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000181652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA146052OtherLABOR & IND.
WA8929331OtherCRIME VICTIMS
WA1099845Medicaid
OR222844Medicaid
WAAB18881Medicare PIN
WA146052OtherLABOR & IND.