Provider Demographics
NPI:1366082463
Name:STALLANT MEDICAL GROUP INC
Entity type:Organization
Organization Name:STALLANT MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFFENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-460-1802
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:WEIMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95736-0518
Mailing Address - Country:US
Mailing Address - Phone:707-460-1802
Mailing Address - Fax:
Practice Address - Street 1:515 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8342
Practice Address - Country:US
Practice Address - Phone:707-460-1802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty