Provider Demographics
NPI:1710999487
Name:STAMM, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:STAMM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1325 ANGELS PATH RD
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-4050
Mailing Address - Country:US
Mailing Address - Phone:920-338-2855
Mailing Address - Fax:920-338-9270
Practice Address - Street 1:1325 ANGELS PATH RD
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-4050
Practice Address - Country:US
Practice Address - Phone:920-338-2855
Practice Address - Fax:920-338-9270
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI301672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31524900Medicaid
WI000144550Medicare ID - Type Unspecified
WI31524900Medicaid