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General NPI Number Information
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NPI Number | 1558014811
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Entity Type | Individual
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Provider Name | DARREN GREGORY STOUB PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 709 W MAIN ST
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City | MANCHESTER
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State | IA
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Zip | 52057-1526
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Country | US
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Telephone | 563-927-3232
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Fax |
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Provider Business Mailing Address
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Address Line | 33922 JOHNSON DR
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City | SIOUX CITY
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State | IA
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Zip | 51108-8692
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Country | US
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Telephone | 712-253-9429
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2723
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3384
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3384
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 111879
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License Number State | IA
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