Healthcare Provider Details

I. General information

NPI: 1235369422
Provider Name (Legal Business Name): STACIE SUTTON BECK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-3926
US

IV. Provider business mailing address

1019 PACIFIC AVE STE 300 CREDENTIALING
TACOMA WA
98402-4488
US

V. Phone/Fax

Practice location:
  • Phone: 253-441-4742
  • Fax: 253-442-8790
Mailing address:
  • Phone: 253-722-1540
  • Fax: 253-597-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 60298417
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: