Provider Demographics
NPI:1912913971
Name:STAUFFER, MARC ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ROBERT
Last Name:STAUFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10808
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-0808
Mailing Address - Country:US
Mailing Address - Phone:813-870-3971
Mailing Address - Fax:813-872-6594
Practice Address - Street 1:2919 W SWANN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4038
Practice Address - Country:US
Practice Address - Phone:813-870-3971
Practice Address - Fax:813-872-2644
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93781207R00000X, 207RC0000X, 207UN0901X, 207RI0011X
CODR.0066644207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I48966Medicare UPIN