Healthcare Provider Details

I. General information

NPI: 1083695720
Provider Name (Legal Business Name): ANTHONY STAUFFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W COAST HWY
NEWPORT BEACH CA
92663-4007
US

IV. Provider business mailing address

PO BOX 6593
ORANGE CA
92863-6593
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-4400
  • Fax: 949-646-4485
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG37591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: