Provider Demographics
NPI:1467557892
Name:STAPERT, JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:STAPERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6232 N 7TH ST
Mailing Address - Street 2:SUITE 206-B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1839
Mailing Address - Country:US
Mailing Address - Phone:602-279-0098
Mailing Address - Fax:602-279-8920
Practice Address - Street 1:6232 N 7TH ST
Practice Address - Street 2:SUITE 206-B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1839
Practice Address - Country:US
Practice Address - Phone:602-279-0098
Practice Address - Fax:602-279-8920
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1784103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R96571Medicare UPIN
PHD1784Medicare ID - Type Unspecified