Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | ME0061689 | FL |
NPI | 1235113671 |
---|---|
Provider Name | Mr. Marshall E Stauber |
First Address | Hollywood, FL 33021-8282 |
Second Address | Hollywood, FL 33021-8282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000385 | AVMED (01) | |
002329 | NHP (01) | |
F32627 | (02) |