MEDICARE: VALERIE D. STOGDILL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	10000147A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000638371	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1497744437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE D. STOGDILL PA-C

Provider Business Mailing Address
First Line	:	6920 POINTE INVERNESS WAY STE 200
Second Line	:	MEDPARTNERS, ATTN: BARB COPELAND
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7934
Country	:	US
Telephone Number	:	260-479-3514
Fax Number	:	260-479-3520

Provider Business Practice Location Address
First Line	:	7900 W JEFFERSON BLVD
Second Line	:	SUITE 201
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4128
Country	:	US
Telephone Number	:	260-432-2297
Fax Number	:	260-969-7266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	01/05/2017

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