Healthcare Provider Details

I. General information

NPI: 1124023643
Provider Name (Legal Business Name): DEBRA ANN STUMPF HOLLISTER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA STUMPF HOLLISTER D.O.

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 HOUMA BLVD STE 300
METAIRIE LA
70006
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 504-264-5142
  • Fax: 504-455-2648
Mailing address:
  • Phone: 504-264-5142
  • Fax: 504-455-2648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-00-7136-H
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO.000130
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: