Individual
DR. JONATHAN ANDREW STASER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
429 S LANDMARK AVENUE, BLOOMINGTON, IN 47403-5003
(812) 332-8242
(812) 333-7684
Mailing address
PO BOX 4366, BLOOMINGTON, IN 47402-4366
(812) 332-8242
(812) 333-7684
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01060288A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200864320
—
IN
01
—
50249
WELLMARK BCBS
IA
Enumeration date
03/28/2007
Last updated
07/26/2013
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