Provider Demographics
NPI:1700889615
Name:STAMER, PAUL LESLIE (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LESLIE
Last Name:STAMER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 N LA CHOLLA BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3533
Mailing Address - Country:US
Mailing Address - Phone:520-797-8550
Mailing Address - Fax:520-797-6986
Practice Address - Street 1:6080 N LA CHOLLA BLVD # 200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3533
Practice Address - Country:US
Practice Address - Phone:520-797-8550
Practice Address - Fax:520-797-6986
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3045363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z1643OtherHEALTH NET
AZ964113OtherUSA MANAGED CARE ORGANIZA
AZ896706Medicaid
AZ2Z1643OtherHEALTH NET
AZQ31395Medicare UPIN
AZ896706Medicaid
AZZ100241Medicare PIN