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Organization
THEODORE E. STAAHL MD INC
Active
Organization
THEODORE E. STAAHL MD INC
Active
Other names
MD Laser Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY STAAHL (ADMINISTRATOR/OFFICE MANAGER)
(209) 577-5700
Entity
Organization
Contact information
Practice address
1329 SPANOS CT, SUITE A-1, MODESTO, CA 95355-2806
(209) 577-5700
(209) 577-5968
Mailing address
1329 SPANOS CT, SUITE A-1, MODESTO, CA 95355-2806
(209) 577-5700
(209) 577-5968
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
G37452
CA
Other
Enumeration date
08/12/2010
Last updated
11/09/2022
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