Provider Demographics
NPI:1154762581
Name:STUTMAN PLASTIC SURGERY PC
Entity type:Organization
Organization Name:STUTMAN PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:L
Authorized Official - Last Name:STUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-488-3388
Mailing Address - Street 1:8776 E SHEA BLVD
Mailing Address - Street 2:STE 106-470
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6629
Mailing Address - Country:US
Mailing Address - Phone:480-488-3388
Mailing Address - Fax:480-907-2405
Practice Address - Street 1:9977 N 90TH ST
Practice Address - Street 2:STE 178
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4423
Practice Address - Country:US
Practice Address - Phone:480-488-3388
Practice Address - Fax:480-907-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ160991Medicare UPIN