Individual
IAN STUPPEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
500 5TH AVE, OWEGO, NY 13827-1620
(607) 687-1122
(607) 687-4725
Mailing address
500 5TH AVE, OWEGO, NY 13827-1620
(607) 687-1122
(607) 687-4725
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
224046
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02280582
—
NY
Enumeration date
11/13/2006
Last updated
03/18/2021
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