Healthcare Provider Details

I. General information

NPI: 1225060510
Provider Name (Legal Business Name): ROBERT STUMP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 N CALIFORNIA ST SUITE G
STOCKTON CA
95204-5500
US

IV. Provider business mailing address

2626 N CALIFORNIA ST SUITE G
STOCKTON CA
95204-5500
US

V. Phone/Fax

Practice location:
  • Phone: 209-464-9846
  • Fax: 209-464-4082
Mailing address:
  • Phone: 209-464-9846
  • Fax: 209-464-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG46401
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG46401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: