Provider Demographics
NPI:1447246574
Name:STAMM, BRYAN K (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:K
Last Name:STAMM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W 5TH AVE
Mailing Address - Street 2:200W
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204
Mailing Address - Country:US
Mailing Address - Phone:509-624-2313
Mailing Address - Fax:509-459-0686
Practice Address - Street 1:104 W 5TH AVE
Practice Address - Street 2:200W
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204
Practice Address - Country:US
Practice Address - Phone:509-624-2313
Practice Address - Fax:509-459-0686
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6675207Q00000X
WAMD00027416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID00392830Medicaid
WA8119950Medicaid
R37717Medicare UPIN
E37717Medicare UPIN
1130992Medicare ID - Type Unspecified