Individual
JERRY T STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 MIDDLE ST, AUGUSTA, ME 04330-5728
(207) 629-9488
(207) 622-8796
Mailing address
55 MIDDLE ST, AUGUSTA, ME 04330-5728
(207) 629-9488
(207) 622-8796
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2002023337
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00283188
RR MEDICARE
MO
Enumeration date
06/24/2006
Last updated
11/06/2007
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