Provider Demographics
NPI:1104051721
Name:STUMPHY, JESSICA EILEEN (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:EILEEN
Last Name:STUMPHY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:EAST BUILDING, 6TH FLOOR, 8952C
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-624-1133
Mailing Address - Fax:612-626-0639
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:EAST BUILDING, 6TH FLOOR, 8952C
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-624-1133
Practice Address - Fax:612-626-0639
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2015-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IAMD-40199208000000X
MN1082492080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics