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Individual

MRS. SHERI L STOFER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1905 W 19TH ST, MOUNTAIN GROVE, MO 65711-1287
(417) 926-1770
(417) 926-1785
Mailing address
1905 W 19TH ST, MOUNTAIN GROVE, MO 65711-1287
(417) 926-1770
(417) 926-1785

Taxonomy

Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
2003004256
MO
363A00000X
Physician Assistant
Primary
2003004256
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1285957001
MEDICAID (GROUP)
MO
01
26-8535
MEDICARE - RH
MO
01
26D2006074
CLIA
MO
01
597780303
MEDICAID - RH
MO
01
MA2517
MEDICARE (GROUP)
MO
Enumeration date
10/18/2006
Last updated
09/16/2010
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