Healthcare Provider Details

I. General information

NPI: 1568416253
Provider Name (Legal Business Name): STEPHEN R. CUPLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12040 NE 128TH ST
KIRKLAND WA
98034-3013
US

IV. Provider business mailing address

PO BOX 34935 DEPT. 390
SEATTLE WA
98124-1935
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-1000
  • Fax:
Mailing address:
  • Phone: 503-372-2740
  • Fax: 503-372-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00023002
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: