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General NPI Number Information
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NPI Number | 1114172079
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Entity Type | Organization
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Legal Business Name | DEANE A STITES MD INC
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Dates
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Enumeration Date | 11/19/2008
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Last Update Date | 03/04/2010
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Provider Practice Location Address
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Address Line | 10051 LAKE AVE STE 3
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City | TRUCKEE
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State | CA
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Zip | 96161-0445
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Country | US
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Telephone | 530-587-7461
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Fax | 530-587-1149
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Provider Business Mailing Address
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Address Line | 10051 LAKE AVE STE 3
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City | TRUCKEE
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State | CA
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Zip | 96161-0445
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Country | US
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Telephone | 530-587-7461
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Fax | 530-587-1149
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEANE A STITES
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Credential |
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Telephone | 530-587-7461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G31474
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License Number State | CA
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