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General NPI Number Information
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NPI Number | 1568801199
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Entity Type | Organization
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Legal Business Name | MICHAEL STAGNER,M.D. P.C
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 2403 N STOCKTON HILL RD STE 1
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City | KINGMAN
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State | AZ
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Zip | 86401-4188
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Country | US
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Telephone | 928-753-2900
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Fax | 928-753-2944
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Provider Business Mailing Address
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Address Line | 2403 N STOCKTON HILL RD STE 1
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City | KINGMAN
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State | AZ
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Zip | 86401-4188
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Country | US
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Telephone | 928-753-2900
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Fax | 928-753-2944
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MICHELLE RENEE SNOWDEN
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Credential |
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Telephone | 928-753-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 24627
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License Number State | AZ
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