Provider Demographics
NPI:1457325169
Name:STODDARD, SEAN R (DPM)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:R
Last Name:STODDARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 E 1ST AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3547
Mailing Address - Country:US
Mailing Address - Phone:530-342-5621
Mailing Address - Fax:530-342-6506
Practice Address - Street 1:676 E 1ST AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3547
Practice Address - Country:US
Practice Address - Phone:530-342-5621
Practice Address - Fax:530-342-6506
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4852213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6463970001OtherCMS DME PTAN
CAE-4852OtherPROFESSIONAL LICENSE
CAE-4852OtherPROFESSIONAL LICENSE
CAEI325ZMedicare PIN