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General NPI Number Information
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NPI Number | 1508836453
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Entity Type | Individual
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Provider Name | CHARLES ALLEN STILLMAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 03/25/2020
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Provider Practice Location Address
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Address Line | 546 E PINE ST
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City | STOCKTON
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State | CA
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Zip | 95204-5525
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Country | US
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Telephone | 209-467-1000
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Fax | 209-467-7335
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Provider Business Mailing Address
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Address Line | 195 GLORIA CIR
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City | MENLO PARK
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State | CA
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Zip | 94025-3559
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Country | US
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Telephone | 650-450-3150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 20A11027
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License Number State | CA
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