Provider Demographics
NPI:1083695720
Name:STAUFFER, ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:STAUFFER
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 6593
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-6593
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:3300 W COAST HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4007
Practice Address - Country:US
Practice Address - Phone:949-646-4400
Practice Address - Fax:949-646-4485
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG375912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G375910Medicaid
P00464330OtherRAILROAD MEDICARE
CA00G375910OtherBLUE SHIELD
CA300016070OtherRR MEDICARE
CA00G375910Medicaid
CAWG37591GMedicare PIN
CAWG37591BMedicare PIN
CA300016070OtherRR MEDICARE
CAWG37591HMedicare PIN
CAWG37591AMedicare PIN
P00464330OtherRAILROAD MEDICARE
CAWG37591FMedicare PIN