Provider Demographics
NPI:1053307298
Name:ANTHONY, STEPHEN PATRICK (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:PATRICK
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:309 E FARWELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-8202
Practice Address - Country:US
Practice Address - Phone:509-464-2873
Practice Address - Fax:509-466-0914
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001601207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8226334Medicaid
000010143048OtherBLUE SHIELD OF IDAHO
ID805167400Medicaid
TX83004753OtherRAILROAD MEDICARE
WA121591OtherLABOR & INDUSTRIES
5337010OtherAETNA
AN7110OtherASURIS NW HEALTH
KF781OtherBLUE CROSS OF IDAHO
ID805167400Medicaid
TXABO4161Medicare PIN