Individual
DWIGHT LEE STAUFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2209 JOHN R WOODEN DR, MARTINSVILLE, IN 46151-1840
(765) 352-9536
(765) 349-6433
Mailing address
4883 E HERITAGE WOODS RD, BLOOMINGTON, IN 47401-9313
(812) 320-0030
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
01025006
IN
207VX0000X
Obstetrics Physician
01025006
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003455410
—
IN
01
—
1104827633
GROUP NPI
IN
01
—
200377200
MEDICAID GROUP
IN
Enumeration date
06/27/2006
Last updated
12/29/2015
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