Provider Demographics
NPI:1770573255
Name:STOOPACK, CHARLES E (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:STOOPACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2067 W VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6001
Mailing Address - Country:US
Mailing Address - Phone:760-758-3000
Mailing Address - Fax:760-758-5943
Practice Address - Street 1:2067 W VISTA WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6031
Practice Address - Country:US
Practice Address - Phone:760-758-3000
Practice Address - Fax:760-758-5943
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG45525207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG45525OtherSTATE MEDICAL LICENSE
CAA50076Medicare UPIN