=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710977764
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOWARD D STANG M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2005
-----------------------------------------------------
Last Update Date | 09/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 309 E FARWELL RD SUITE 100
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99218-2225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-464-2873
-----------------------------------------------------
Fax | 509-466-0914
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 E FARWELL RD SUITE 100
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99218-8202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-464-2873
-----------------------------------------------------
Fax | 509-466-0914
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | MD00020536
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------