Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 39434 | MN |
N | 111NI0900X | Internist | 39434 | MN |
Y | 207RI0200X | Infectious Disease | 39434 | MN |
NPI | 1093781049 |
---|---|
Provider Name | William M Stauffer III |
First Address | Minneapolis, MN 55414 |
Second Address | Minneapolis, MN 55455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 01/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
246593100 | (05) | MN |
H38810 | (02) |