Provider Demographics
NPI:1336197326
Name:COULTHARD, STANLEY W (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:W
Last Name:COULTHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6565 E CARONDELET DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2157
Mailing Address - Country:US
Mailing Address - Phone:520-296-8500
Mailing Address - Fax:520-733-2389
Practice Address - Street 1:1980 W HOSPITAL DR
Practice Address - Street 2:SUITE 111
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7802
Practice Address - Country:US
Practice Address - Phone:520-575-1272
Practice Address - Fax:520-575-1787
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ9899207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ204529Medicaid
AZZ22711Medicare ID - Type Unspecified
AZ204529Medicaid
AZZ22712Medicare ID - Type Unspecified