# THEODORE E. STAAHL MD INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MD Laser Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467767541
- **Authorized official:** MRS. NANCY STAAHL (ADMINISTRATOR/OFFICE MANAGER)
- **Authorized official phone:** (209) 577-5700

## Contact information

- **Practice address:** 1329 SPANOS CT, SUITE A-1, MODESTO, CA 95355-2806
- **Practice address phone:** (209) 577-5700
- **Practice address fax:** (209) 577-5968
- **Mailing address:** 1329 SPANOS CT, SUITE A-1, MODESTO, CA 95355-2806
- **Mailing address phone:** (209) 577-5700
- **Mailing address fax:** (209) 577-5968

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | G37452 | CA | Yes |

## Other

- **Enumeration date:** 08/12/2010
- **Last updated:** 11/09/2022