Healthcare Provider Details

I. General information

NPI: 1124080478
Provider Name (Legal Business Name): BRUCE ALBERT STINNETT V MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

6022 FOX HAVEN CT
WOODBRIDGE VA
22193-4008
US

V. Phone/Fax

Practice location:
  • Phone: 703-324-0227
  • Fax: 703-784-1987
Mailing address:
  • Phone: 850-341-0141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101259452
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: