Healthcare Provider Details

I. General information

NPI: 1760019574
Provider Name (Legal Business Name): KYLE STUMETZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

1 MEDICAL DR DEPT OF
LEBANON NH
03756-0001
US

V. Phone/Fax

Practice location:
  • Phone: 509-947-3755
  • Fax:
Mailing address:
  • Phone: 509-947-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number39227
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: