Provider Demographics
NPI:1558636548
Name:JOHN STOUFFER MD INC
Entity Type:Organization
Organization Name:JOHN STOUFFER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:STOUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-827-5140
Mailing Address - Street 1:3010 W ORANGE AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3174
Mailing Address - Country:US
Mailing Address - Phone:714-827-5140
Mailing Address - Fax:
Practice Address - Street 1:3010 W ORANGE AVE STE 501
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3174
Practice Address - Country:US
Practice Address - Phone:714-827-5140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66916261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66916Medicaid
CAG66916Medicare PIN
CAF34460Medicare UPIN