=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861503260
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN PLYMATE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1660 S COLUMBIAN WAY
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98108-1532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-762-1010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24935 8TH PL S
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98198-8527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-824-4666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | MD00018159
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------