Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4658 | AZ |
Y | 208600000X | Surgeon | 4658 | AZ |
N | 208200000X | Surgeon | OS10828 | FL |
N | 208600000X | Surgeon | OS10828 | FL |
NPI | 1003015918 |
---|---|
Provider Name | Dr. Michael J Stumpf |
First Address | Phoenix, AZ 85331 |
Second Address | Phoenix, AZ 85050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 20/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270795 | (05) | AZ |