Provider Demographics
NPI:1154487726
Name:GOCKEL, STAMATIA FISSAS (DO)
Entity Type:Individual
Prefix:DR
First Name:STAMATIA
Middle Name:FISSAS
Last Name:GOCKEL
Suffix:
Gender:F
Credentials:DO
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 669
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2329
Mailing Address - Country:US
Mailing Address - Phone:928-247-6516
Mailing Address - Fax:
Practice Address - Street 1:11611 S FOOTHILLS BLVD STE C
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-5845
Practice Address - Country:US
Practice Address - Phone:928-342-1814
Practice Address - Fax:928-342-6154
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3285207Q00000X
OH34005447G207Q00000X
AZ7385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F68158Medicare UPIN
AZZ29430Medicare PIN