Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT7675 | TX |
Y | 213ES0000X | Sports Medicine | AT7675 | TX |
NPI | 1174000590 |
---|---|
Provider Name | Andrew Staehling |
First Address | Nacogdoches, TX 75962-3010 |
Second Address | Nacogdoches, TX 75962-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2018 |
Last Update Date | 27/07/2018 |