Provider Demographics
NPI:1659536761
Name:STUTZMAN, MARK ALAN (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:STUTZMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3477 COMMERCE PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7126
Mailing Address - Country:US
Mailing Address - Phone:330-601-0999
Mailing Address - Fax:330-601-0935
Practice Address - Street 1:3477 COMMERCE PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7126
Practice Address - Country:US
Practice Address - Phone:330-601-0999
Practice Address - Fax:330-601-0935
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS015821207Q00000X
OH34011365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105072Medicaid
OH0105072Medicaid