Provider Demographics
NPI:1982662508
Name:STAIR, DORIS R (MD)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:R
Last Name:STAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10835 N 25TH AVE
Mailing Address - Street 2:#240
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4751
Mailing Address - Country:US
Mailing Address - Phone:602-246-2584
Mailing Address - Fax:602-246-2566
Practice Address - Street 1:10835 N 25TH AVE
Practice Address - Street 2:#240
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4751
Practice Address - Country:US
Practice Address - Phone:602-246-2584
Practice Address - Fax:602-246-2566
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY547742085N0700X, 2085R0202X
PAMD4662012085N0700X, 2085R0202X
MA1594972085R0202X
AZ420752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ433257Medicaid
AZ433257Medicaid
AZZ133459Medicare PIN