Provider Demographics
NPI:1215261292
Name:DAVID M STAUFFER, DPM, PLLC
Entity type:Organization
Organization Name:DAVID M STAUFFER, DPM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:336-783-8231
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-0717
Mailing Address - Country:US
Mailing Address - Phone:336-783-8231
Mailing Address - Fax:336-983-0012
Practice Address - Street 1:167 MOORE RD
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-8770
Practice Address - Country:US
Practice Address - Phone:336-783-8231
Practice Address - Fax:336-983-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908171Medicaid
NC6342450001Medicare NSC
NC243038LMedicare PIN