Individual
DR. JEREMY JAMES STALLBAUMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1947 N FOUNDERS CIR, WICHITA, KS 67206-3548
(316) 613-4640
(316) 689-9769
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
2010010946
MO
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
04-35526
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200974790B
—
KS
Enumeration date
05/02/2007
Last updated
12/30/2013
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