Provider Demographics
NPI:1063726792
Name:STAUFFER, CHARLES BENNETT (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BENNETT
Last Name:STAUFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 E SUPERSTITION SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-4001
Mailing Address - Country:US
Mailing Address - Phone:480-641-4000
Mailing Address - Fax:
Practice Address - Street 1:6811 E SUPERSTITION SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-4001
Practice Address - Country:US
Practice Address - Phone:480-641-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR72059207R00000X
AZ47803207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine