Individual
EARL STODDARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
147 W CHUBBUCK RD, CHUBBUCK, ID 83202-2314
(208) 238-7546
(208) 237-9643
Mailing address
147 W CHUBBUCK RD, CHUBBUCK, ID 83202-2314
(208) 238-7546
(208) 237-9643
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
M9280
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807206400
—
ID
01
—
P00239843
RAILRAOD MEDICARE PTAN
ID
Enumeration date
07/17/2006
Last updated
08/18/2020
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