MEDICARE: DR. GARY STANLEY STOUDER

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	207Q00000X	Family Medicine Physician	01027577A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4072302	OTHER	IN	AETNA PIN #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000396462	OTHER	IN	ANTHEM PIN #

General Provider Information

NPI Number	:	1922092931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY STANLEY STOUDER

Provider Business Mailing Address
First Line	:	PO BOX 129
Second Line	:
City	:	GREENFIELD
State	:	IN
Zip	:	46140-0129
Country	:	US
Telephone Number	:	317-468-6270
Fax Number	:	317-468-6268

Provider Business Practice Location Address
First Line	:	8535 NORTH CLEARVIEW DRIVE
Second Line	:	SUITE 200
City	:	MCCORDSVILLE
State	:	IN
Zip	:	46055-6055
Country	:	US
Telephone Number	:	317-335-6960
Fax Number	:	317-335-5031

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	10/14/2010

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Directions to “ DR. GARY STANLEY STOUDER ” Practice Location

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