Provider Demographics
NPI:1194766154
Name:STUTZMAN, DONALD P (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:P
Last Name:STUTZMAN
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 1:1080 SOUTHEAST SUNNYSIDE ROAD
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9303
Mailing Address - Country:US
Mailing Address - Phone:503-652-2880
Mailing Address - Fax:503-375-5729
Practice Address - Street 1:10180 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-8970
Practice Address - Country:US
Practice Address - Phone:503-554-1187
Practice Address - Fax:503-571-2666
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14178174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164186Medicaid
OR164186Medicaid
ORC65576Medicare UPIN