Basic Information
| Provider Information | |||||||||
| NPI: | 1164483350 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOFFA | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3009 N BALLAS RD STE 100B | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144321111 | ||||||||
| FaxNumber: | 3144327317 | ||||||||
| Practice Location | |||||||||
| Address1: | 3009 N BALLAS RD STE 100B | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144321111 | ||||||||
| FaxNumber: | 3144327317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 01/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 103680 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207R00000X | 103680 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 208802900 | 05 | MO | MEDICAID |