Provider Demographics
NPI:1336142355
Name:STANDERFER, ROBERT JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAY
Last Name:STANDERFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1144 E MCDOWELL RD
Mailing Address - Street 2:STE 406
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2664
Mailing Address - Country:US
Mailing Address - Phone:602-253-9009
Mailing Address - Fax:602-253-7066
Practice Address - Street 1:1144 E MCDOWELL RD
Practice Address - Street 2:STE 406
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2664
Practice Address - Country:US
Practice Address - Phone:602-253-9009
Practice Address - Fax:602-253-7066
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ14662208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD37689Medicare UPIN
AZZ554622516Medicare ID - Type Unspecified