Healthcare Provider Details

I. General information

NPI: 1790803443
Provider Name (Legal Business Name): STANLEY LALIT KUMAR FLEMMING D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7619 CHAMBERS CREEK RD W
UNIVERSITY PLACE WA
98467-2015
US

IV. Provider business mailing address

511 10TH AVE SE LIFE CARE CTR OF PUYALLUP
PUYALLUP WA
98372-3875
US

V. Phone/Fax

Practice location:
  • Phone: 253-564-6675
  • Fax: 253-566-1149
Mailing address:
  • Phone: 251-845-7566
  • Fax: 253-845-3386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1122
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number1122
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: