Provider Demographics
NPI:1447201587
Name:STAUFFER, DAVID MARK (DPM PLLC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:STAUFFER
Suffix:
Gender:M
Credentials:DPM PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-0172
Mailing Address - Country:US
Mailing Address - Phone:336-983-8231
Mailing Address - Fax:336-983-0012
Practice Address - Street 1:2825 LYNDHURST AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4146
Practice Address - Country:US
Practice Address - Phone:336-768-3305
Practice Address - Fax:336-768-3350
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8968324Medicaid
NC08171OtherBCBS PROVIDER NUMBER
NC243038HMedicare ID - Type UnspecifiedELKIN MEDICARE
NC08171OtherBCBS PROVIDER NUMBER
NC8968324Medicaid