Individual
JACK ALLAN STAUFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
435 N CEDAR ST, SUMMERVILLE, SC 29483-6407
(843) 873-1592
(843) 820-3373
Mailing address
201 SIGMA DR, STE 100, SUMMERVILLE, SC 29486-7715
(843) 554-8312
(843) 554-5141
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
629
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP0021
—
SC
01
—
P00851396
RR MEDICARE PTAN
SC
Enumeration date
05/03/2006
Last updated
08/30/2016
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