# ZANE STAUBACH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1720594104
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0101X | Anatomic Pathology Physician | TL.0005888 | CO | — |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | 73434-20 | WI | Yes |

## Other

- **Enumeration date:** 12/20/2017
- **Last updated:** 08/03/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 73434-20 | MEDICAL LICENSE | WI |