Provider Demographics
NPI:1710106703
Name:STAUFFER, REBECCA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 HARPST ST
Mailing Address - Street 2:HUMBOLDT STATE UNIVERSITY
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-8222
Mailing Address - Country:US
Mailing Address - Phone:707-826-5029
Mailing Address - Fax:707-826-5042
Practice Address - Street 1:1 HARPST ST
Practice Address - Street 2:HUMBOLDT STATE UNIVERSITY
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-8222
Practice Address - Country:US
Practice Address - Phone:707-826-5029
Practice Address - Fax:707-826-5042
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50694208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics