Provider Demographics
NPI:1316920010
Name:TRIESTER, STUART L (MD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:L
Last Name:TRIESTER
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 1:7351 E OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6451
Mailing Address - Country:US
Mailing Address - Phone:480-882-5335
Mailing Address - Fax:480-882-4305
Practice Address - Street 1:20401 N 73RD ST
Practice Address - Street 2:SUITE 275
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4108
Practice Address - Country:US
Practice Address - Phone:480-945-2321
Practice Address - Fax:480-946-3711
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039076207RG0100X
AZ38123207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ766595Medicaid
WA8279671Medicaid
AZ766595Medicaid
WA8279671Medicaid
WA8860611Medicare PIN