Healthcare Provider Details

I. General information

NPI: 1891798112
Provider Name (Legal Business Name): PAUL F. STEMMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 03/07/2023
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N HERITAGE DR STE A
RIDGECREST CA
93555-5540
US

IV. Provider business mailing address

1081 N CHINA LAKE BLVD
RIDGECREST CA
93555-3130
US

V. Phone/Fax

Practice location:
  • Phone: 760-446-3700
  • Fax: 760-446-3705
Mailing address:
  • Phone: 760-446-3551
  • Fax: 760-499-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG63347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: