Healthcare Provider Details

I. General information

NPI: 1104969955
Provider Name (Legal Business Name): JOHN LEE STAUFFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JACK STAUFFER M.D.

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3172 PORTER DR
PALO ALTO CA
94304-1212
US

IV. Provider business mailing address

555 W MIDDLEFIELD RD M308
MOUNTAIN VIEW CA
94043-3543
US

V. Phone/Fax

Practice location:
  • Phone: 650-384-8091
  • Fax:
Mailing address:
  • Phone: 650-694-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD034019E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD034019E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD034019E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: