Provider Demographics
NPI:1205816097
Name:STOMEL, ROBERT J (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:STOMEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:804 AINSWORTH DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1624
Mailing Address - Country:US
Mailing Address - Phone:928-776-0601
Mailing Address - Fax:928-776-0620
Practice Address - Street 1:804 AINSWORTH DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1624
Practice Address - Country:US
Practice Address - Phone:928-776-0601
Practice Address - Fax:928-776-0620
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4589207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ349061Medicaid
AZ349061Medicaid
AZZ123528Medicare PIN
E33237Medicare UPIN