Provider Demographics
NPI:1164423273
Name:STIERMAN, SAMUEL JACOB (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JACOB
Last Name:STIERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5701 W TALAVI BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1887
Mailing Address - Country:US
Mailing Address - Phone:602-843-1313
Mailing Address - Fax:602-843-0191
Practice Address - Street 1:5601 W EUGIE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1255
Practice Address - Country:US
Practice Address - Phone:602-843-1313
Practice Address - Fax:602-843-0191
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-04-30
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Provider Licenses
StateLicense IDTaxonomies
AZ19199207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110173205OtherRR MEDICARE
860923905OtherHUMANA PPO
AZ824340OtherBCBS
1031014OtherAETNA
5197885006OtherCIGNA 200
5197885007OtherCIGNA 210
1Z7305OtherHEALTH NET
1Z7305OtherHEALTH NET
E47408Medicare UPIN