Provider Demographics
NPI:1316466345
Name:STAMPFLY, ZANE (PA-C)
Entity type:Individual
Prefix:
First Name:ZANE
Middle Name:
Last Name:STAMPFLY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7775 ANGLING RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-7427
Mailing Address - Country:US
Mailing Address - Phone:269-324-8670
Mailing Address - Fax:
Practice Address - Street 1:7775 ANGLING RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-7427
Practice Address - Country:US
Practice Address - Phone:269-324-8670
Practice Address - Fax:269-321-7154
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
MI5601008359363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant