Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | BP10033795 | TX |
N | 208600000X | Surgeon | BP10033795 | TX |
Y | 2086S0120X | Pediatric Surgery | P2538 | TX |
NPI | 1316231475 |
---|---|
Provider Name | Dr. Hayden Wilson Stagg |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76502-1814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 05/11/2020 |