Provider Demographics
NPI:1407833692
Name:STOODY, JAMES C (M D)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:STOODY
Suffix:
Gender:M
Credentials:M D
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Other - Last Name:
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Mailing Address - Street 1:2 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3043
Mailing Address - Country:US
Mailing Address - Phone:916-783-7515
Mailing Address - Fax:916-783-8095
Practice Address - Street 1:2 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 260
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3043
Practice Address - Country:US
Practice Address - Phone:916-783-7515
Practice Address - Fax:916-783-8095
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC4040662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C404660Medicaid
CA00C404660Medicaid
CAA37372Medicare UPIN