Basic Information
| Provider Information | |||||||||
| NPI: | 1679550180 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STIFF | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | ALLYN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 885 S SAWBURG AVE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | ALLIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446015926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308231112 | ||||||||
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| Practice Location | |||||||||
| Address1: | 269 GILLMAN RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280377923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046603322 | ||||||||
| FaxNumber: | 7046603330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2005 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 2017-00465 | NC | Y | Allopathic & Osteopathic Physicians | Urology | 208800000X | 71878 | OH | N | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 340014975 | 01 | OH | RAIROAD MEDICARE | OTHER | 2047216 | 05 | OH | MEDICAID |