Individual
SONI ELIZABETH STAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 E 5TH ST, DOUGLAS, AZ 85607-2859
(520) 364-7659
(520) 364-8541
Mailing address
3815 E EDNA AVE, PHOENIX, AZ 85032-2101
(313) 570-1752
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
40468
AZ
208600000X
Surgery Physician
40468
AZ
208D00000X
General Practice Physician
Primary
40468
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
362117
—
AZ
Enumeration date
07/26/2007
Last updated
09/12/2022
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