Individual
TERRY L STAKE
Active
Individual
TERRY L STAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
14313
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000864293
MT STATE BCBS
WV
05
—
0117198000
—
WV
05
—
0222011
—
OH
01
—
14313A
HEALTH PLAN OF UPPER OH V
—
01
—
300040909
RAILROAD MEDICARE
OH
01
—
300117903
RAILROAD MEDICARE
WV
Enumeration date
03/03/2006
Last updated
07/08/2011
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