Basic Information
| Provider Information | |||||||||
| NPI: | 1902932247 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THORSON | ||||||||
| FirstName: | STUART | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 SE 164TH AVE DEPT 358 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986838004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607291462 | ||||||||
| FaxNumber: | 3607293104 | ||||||||
| Practice Location | |||||||||
| Address1: | 2980 SQUALICUM PKWY STE 301 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607886112 | ||||||||
| FaxNumber: | 3607886114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00018372 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | MD00018372 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RS0012X | MD00018372 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RP1001X | MD00018372 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 8303737 | 05 | WA | MEDICAID | P00670536 | 01 | WA | RAILROAD MEDICARE | OTHER | 1902932247 | 05 | WA | MEDICAID | 221341 | 05 | OR | MEDICAID | 0237220 | 01 | WA | L&I AND CRIME VICTIMS | OTHER | 3141TH | 01 | WA | REGENCE | OTHER | 4411689 | 01 | WA | AETNA | OTHER | MD0850W | 05 | AK | MEDICAID |