Provider Demographics
NPI:1932262193
Name:STAMAN, MARC J (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:J
Last Name:STAMAN
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 1:12421 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-4815
Mailing Address - Country:US
Mailing Address - Phone:602-819-2731
Mailing Address - Fax:
Practice Address - Street 1:12421 N 76TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-4815
Practice Address - Country:US
Practice Address - Phone:602-819-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12163207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ223222OtherMERCY CARE PLAN
AZ2232222003Medicaid
AZ110216334OtherRAILROAD MEDICARE
CAXPY191321OtherMEDI-CAL
AZP02958OtherPHOENIX HEALTH PLAN
AZAZ0871010OtherBLUE CROSS
AZAZ0871010OtherBLUE CROSS
AZ2232222003Medicaid