Active NPI
Robert Earl Stam Jr.
- Durable Medical Equipment & Medical Supplies
- Tacoma, WA
National Provider Identifier
1487911665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 601094776
- Practice address
- 5510 6TH Ave
Suite C
Tacoma, WA 98406-2646 - Phone
- (253) 752-7900
- NPI assigned
- Apr 12, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 601094776 | WA | Primary |
Addresses
Primary practice location
5510 6TH Ave
Suite C
Tacoma, WA 98406-2646
Mailing address
5510 6TH Ave
Suite C
Tacoma, WA 98406-2646
Phone (253) 752-7900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 601094776 | WA | MD | Durable Medical Equipment & Medical Supplies |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334188800000",
"number": "1487911665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5510 6TH AVE",
"address_2": "SUITE C",
"city": "TACOMA",
"state": "WA",
"postal_code": "984062646",
"telephone_number": "253-752-7900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5510 6TH AVE",
"address_2": "SUITE C",
"city": "TACOMA",
"state": "WA",
"postal_code": "984062646",
"telephone_number": "253-752-7900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAM",
"first_name": "ROBERT",
"middle_name": "EARL",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-04-12",
"last_updated": "2012-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "WA",
"license": "601094776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.