Provider Demographics
NPI:1578585519
Name:JUNEAU D STUMP JR MD PC
Entity Type:Organization
Organization Name:JUNEAU D STUMP JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUNEAU
Authorized Official - Middle Name:D
Authorized Official - Last Name:STUMP
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:928-634-2233
Mailing Address - Street 1:PO BOX 1904
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-1904
Mailing Address - Country:US
Mailing Address - Phone:928-634-0665
Mailing Address - Fax:
Practice Address - Street 1:18 E BEECH ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4134
Practice Address - Country:US
Practice Address - Phone:928-634-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ204008Medicaid
AZ204008Medicaid
AZZ526501472Medicare PIN