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General NPI Number Information
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NPI Number | 1811924475
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Entity Type | Individual
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Provider Name | DWIGHT LEE STAUFFER MD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 2209 JOHN R WOODEN DR
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City | MARTINSVILLE
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State | IN
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Zip | 46151-1840
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Country | US
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Telephone | 765-352-9536
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Fax | 765-349-6433
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Provider Business Mailing Address
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Address Line | 4883 E HERITAGE WOODS RD
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City | BLOOMINGTON
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State | IN
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Zip | 47401-9313
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Country | US
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Telephone | 812-320-0030
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 01025006
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 01025006
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License Number State | IN
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