Provider Demographics
NPI:1255481347
Name:STAUFFER, WILLIAM S (CPO)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:S
Last Name:STAUFFER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 SAWBUCK CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1613
Mailing Address - Country:US
Mailing Address - Phone:919-870-5396
Mailing Address - Fax:
Practice Address - Street 1:1306 WAYNE MEMORIAL DR STE C
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2257
Practice Address - Country:US
Practice Address - Phone:919-736-1010
Practice Address - Fax:919-736-1011
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795078Medicaid