Provider Demographics
NPI:1427109685
Name:STAUFFER, ROBERT F (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:STAUFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:F
Other - Last Name:STAUFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1496 E 5600 S STE 4
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4822
Mailing Address - Country:US
Mailing Address - Phone:801-475-0712
Mailing Address - Fax:801-475-7139
Practice Address - Street 1:1496 E 5600 S STE 4
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4822
Practice Address - Country:US
Practice Address - Phone:801-475-0712
Practice Address - Fax:801-475-7139
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT17682012052084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT$$$$$$$$$017Medicaid
UT006382006Medicare PIN
UT$$$$$$$$$017Medicaid