Provider Demographics
NPI:1285791079
Name:STANKUS, SETH J (DO)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:J
Last Name:STANKUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 POINT FOSDICK DR NW STE 111
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-926-7344
Mailing Address - Fax:253-426-6344
Practice Address - Street 1:4700 POINT FOSDICK DR NW STE 111
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-926-7344
Practice Address - Fax:253-426-6344
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO291162084N0400X
WAOP000018852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA264258OtherSTATE L&I
OR500605945Medicaid
WA8388886Medicaid
WA264261OtherSTATE L&I
WA264263OtherSTATE L&I
WAG8801035Medicare PIN
WAG8801033Medicare PIN
WA264258OtherSTATE L&I
WAI00722Medicare UPIN
WAG8892266Medicare PIN
WA8388886Medicaid
WA264261OtherSTATE L&I
WAG8801039Medicare PIN
R147058Medicare PIN