Provider Demographics
NPI:1881693323
Name:STITZER, PHILIP (DO)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:STITZER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-9469
Mailing Address - Country:US
Mailing Address - Phone:660-263-4770
Mailing Address - Fax:660-263-2228
Practice Address - Street 1:1501 UNION AVE
Practice Address - Street 2:SUITE C & D
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9469
Practice Address - Country:US
Practice Address - Phone:660-263-4770
Practice Address - Fax:660-263-2228
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7J97207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE35346Medicare UPIN
MO080178914Medicare PIN