Provider Demographics
NPI:1699330621
Name:STOFFER, KEVIN DAVID (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:DAVID
Last Name:STOFFER
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 1:1313 21ST AVE. SOUTH
Mailing Address - Street 2:703 OXFORD HOUSE
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-4700
Mailing Address - Country:US
Mailing Address - Phone:936-615-0087
Mailing Address - Fax:
Practice Address - Street 1:1313 21ST AVE. SOUTH
Practice Address - Street 2:703 OXFORD HOUSE
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-4700
Practice Address - Country:US
Practice Address - Phone:423-833-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000063670207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty