Provider Demographics
NPI:1902892342
Name:STUMPF, PATRICK S (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:S
Last Name:STUMPF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MARYLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070
Mailing Address - Country:US
Mailing Address - Phone:504-349-6411
Mailing Address - Fax:504-349-6415
Practice Address - Street 1:107 MARYLAND DRIVE
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070
Practice Address - Country:US
Practice Address - Phone:504-349-6411
Practice Address - Fax:504-349-6415
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1134864Medicaid
LA55964Medicare PIN
LA357474ZK07Medicare PIN
LAB65931Medicare UPIN