Individual
JESSE C STAUBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
320 CENTRAL AVE STE 304, COOS BAY, OR 97420-2241
(541) 366-7640
Mailing address
PO BOX 802, COOS BAY, OR 97420-0148
(541) 295-9240
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000003807
OR
Other
Enumeration date
10/24/2019
Last updated
10/24/2019
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