Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | C3550 | CA |
NPI | 1639391048 |
---|---|
Provider Name | Dr. John Craig Stauffer |
First Address | Ventura, CA 93003-3099 |
Second Address | Ventura, CA 93003-3099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C3550 | STATE MEDICAL LICENSE (01) | CA |