Basic Information
| Provider Information | |||||||||
| NPI: | 1639134711 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STODDARD | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | DUANE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 WEST MAIN STREET | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | BABYLON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315178006 | ||||||||
| FaxNumber: | 6315178007 | ||||||||
| Practice Location | |||||||||
| Address1: | 398 EAST ALTAMONTE DRIVE | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073319355 | ||||||||
| FaxNumber: | 4073319481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | ME33075 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.