Healthcare Provider Details

I. General information

NPI: 1447201587
Provider Name (Legal Business Name): DAVID MARK STAUFFER DPM PLLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 LYNDHURST AVE SUITE 105
WINSTON-SALEM NC
27103-4146
US

IV. Provider business mailing address

PO BOX 172
KING NC
27021-0172
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3305
  • Fax: 336-768-3350
Mailing address:
  • Phone: 336-983-8231
  • Fax: 336-983-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number91
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: