Healthcare Provider Details

I. General information

NPI: 1033103098
Provider Name (Legal Business Name): DR. STANLEY JOHN STUTZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PEACE ST CORPORATE CARE
PROVIDENCE RI
02907-1510
US

IV. Provider business mailing address

129 FAIRWAY DR
SEEKONK MA
02771-1303
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-4020
  • Fax: 401-456-4203
Mailing address:
  • Phone: 508-761-4891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD 4382
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: