Healthcare Provider Details

I. General information

NPI: 1700979366
Provider Name (Legal Business Name): STEVEN D WASHBURN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 HIGHWAY 260 STE 103
LAKESIDE AZ
85929-5845
US

IV. Provider business mailing address

4830 HIGHWAY 260 STE 103
LAKESIDE AZ
85929-5845
US

V. Phone/Fax

Practice location:
  • Phone: 928-537-8777
  • Fax: 928-537-1914
Mailing address:
  • Phone: 928-537-8777
  • Fax: 928-537-1914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25791
License Number StateAZ

VIII. Authorized Official

Name: DR. STEVEN D WASHBURN
Title or Position: OWNER
Credential: MD
Phone: 928-537-8777