Provider Demographics
NPI:1376307090
Name:STAZER, DOUGLAS GARY JR (CRNP)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:GARY
Last Name:STAZER
Suffix:JR
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-2304
Mailing Address - Country:US
Mailing Address - Phone:814-899-7000
Mailing Address - Fax:814-899-0334
Practice Address - Street 1:4950 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2304
Practice Address - Country:US
Practice Address - Phone:814-899-7000
Practice Address - Fax:814-899-0334
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily