Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | A143877 | CA |
NPI | 1083009609 |
---|---|
Provider Name | Dr. David Wells Staudt |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 08/10/2021 |