MEDICARE: FIELDING BRUDER STAPLETON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0210X	Pediatric Nephrology Physician	MD00033439	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4361	OTHER		INTERNAL ID-MOTOR VEHICLE ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316055288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FIELDING BRUDER STAPLETON MD

Provider Business Mailing Address
First Line	:	4501 SANDPOINT WAY NE, SUITE 100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 SAND POINT WAY NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-3901
Country	:	US
Telephone Number	:	206-987-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	09/08/2008

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