Provider Demographics
NPI:1023178951
Name:STIFF, CARL EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:EARL
Last Name:STIFF
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:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-0946
Mailing Address - Country:US
Mailing Address - Phone:541-523-9320
Mailing Address - Fax:541-523-2813
Practice Address - Street 1:14121 BEN DIER LN
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-8214
Practice Address - Country:US
Practice Address - Phone:541-523-9320
Practice Address - Fax:541-523-2813
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD05896207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR236562Medicaid
OR236562Medicaid
ORC93861Medicare UPIN