Provider Demographics
NPI:1063294247
Name:R THOMAS STOFFER MD PC
Entity type:Organization
Organization Name:R THOMAS STOFFER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLADYMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VRKIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-610-9031
Mailing Address - Street 1:3201 W PEORIA AVE STE C604
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3201 W PEORIA AVE STE C604
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4611
Practice Address - Country:US
Practice Address - Phone:602-993-1773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty