Healthcare Provider Details

I. General information

NPI: 1538190434
Provider Name (Legal Business Name): JOHN MARK STAUFFER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 TULIP TER
ROCKINGHAM VA
22801-5324
US

IV. Provider business mailing address

PO BOX 169
HARRISONBURG VA
22803-0169
US

V. Phone/Fax

Practice location:
  • Phone: 540-421-0779
  • Fax: 540-438-0023
Mailing address:
  • Phone: 540-421-0779
  • Fax: 540-438-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101031417
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: