Healthcare Provider Details

I. General information

NPI: 1215261292
Provider Name (Legal Business Name): DAVID M STAUFFER, DPM, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 MOORE RD
KING NC
27021-8770
US

IV. Provider business mailing address

PO BOX 717
KING NC
27021-0717
US

V. Phone/Fax

Practice location:
  • Phone: 336-783-8231
  • Fax: 336-983-0012
Mailing address:
  • Phone: 336-783-8231
  • Fax: 336-983-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number91
License Number StateNC

VIII. Authorized Official

Name: DR. DAVID M STAUFFER
Title or Position: OWNER
Credential: DPM
Phone: 336-783-8231