Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 006040 | AZ |
NPI | 1033153812 |
---|---|
Provider Name | Dr. Robert D. Stoffey |
First Address | Scottsdale, AZ 85255-5437 |
Second Address | Austin, MN 55912-2941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 08/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
431560263074 | TRICARE (01) | |
H25743 | (02) | MO |
P00313988 | RAILROAD MEDICARE (01) | |
PENDING | (05) | MS |