Provider Demographics
NPI:1164483350
Name:STOFFA, MAUREEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:E
Last Name:STOFFA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 N BALLAS RD STE 100B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-432-1111
Mailing Address - Fax:314-432-7317
Practice Address - Street 1:3009 N BALLAS RD STE 100B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-432-1111
Practice Address - Fax:314-432-7317
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103680207QA0505X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208802900Medicaid
MO900990556Medicare ID - Type Unspecified
MO208802900Medicaid