Individual
DR. GARY STANLEY STOUDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8535 NORTH CLEARVIEW DRIVE, SUITE 200, MCCORDSVILLE, IN 46055-6055
(317) 335-6960
(317) 335-5031
Mailing address
PO BOX 129, GREENFIELD, IN 46140-0129
(317) 468-6270
(317) 468-6268
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01027577A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000396462
ANTHEM PIN #
IN
05
—
100350300
—
IN
01
—
200311740J,G
MEDICAID GROUP#/LOCATION
IN
01
—
4072302
AETNA PIN #
IN
Enumeration date
09/06/2005
Last updated
10/14/2010
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