Provider Demographics
NPI:1538190434
Name:STAUFFER, JOHN MARK JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:STAUFFER
Suffix:JR
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:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-0169
Mailing Address - Country:US
Mailing Address - Phone:540-421-0779
Mailing Address - Fax:540-438-0023
Practice Address - Street 1:1046 TULIP TER
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-5324
Practice Address - Country:US
Practice Address - Phone:540-421-0779
Practice Address - Fax:540-438-0023
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005689660Medicaid
VA080001240Medicare ID - Type Unspecified
B05356Medicare UPIN