Basic Information
| Provider Information | |||||||||
| NPI: | 1700889615 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAMER | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | LESLIE | ||||||||
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| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6080 N LA CHOLLA BLVD # 200 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857413533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207978550 | ||||||||
| FaxNumber: | 5207976986 | ||||||||
| Practice Location | |||||||||
| Address1: | 6080 N LA CHOLLA BLVD # 200 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857413533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207978550 | ||||||||
| FaxNumber: | 5207976986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 02/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 3045 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 2Z1643 | 01 | AZ | HEALTH NET | OTHER | 964113 | 01 | AZ | USA MANAGED CARE ORGANIZA | OTHER | 896706 | 05 | AZ | MEDICAID |