Provider Demographics
NPI:1568436509
Name:STAUFFER, LARRY K (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:K
Last Name:STAUFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1128
Mailing Address - Street 2:CAPITAL REGION FAMILY EYE CARE
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65102-1128
Mailing Address - Country:US
Mailing Address - Phone:573-632-5576
Mailing Address - Fax:573-632-5860
Practice Address - Street 1:1432 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109
Practice Address - Country:US
Practice Address - Phone:573-632-5576
Practice Address - Fax:573-632-5860
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO32512207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
21857OtherBLUE CROSS BLUE SHIELD
109982OtherHEALTHLINK
180038736OtherRR MEDICARE
MO200790814Medicaid
A12009OtherMERCY
815387OtherFIRST HEALTH
180038736OtherRR MEDICARE
A12009Medicare UPIN