Individual
MR. CHARLES LIONEL STAATS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1105 CENTRAL EXPY N, STE 120, ALLEN, TX 75013-6103
(972) 727-9995
(972) 727-8350
Mailing address
1105 CENTRAL EXPY N, STE 120, ALLEN, TX 75013-6103
(972) 727-9995
(972) 727-8350
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01276
TX
363AM0700X
Medical Physician Assistant
PA01276
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
835N16
BC/BS TX - EFFECT. 02/01/2011
TX
01
—
87N310
BCBS
TX
01
—
TXB121232
MEDICARE PART B EFFECT 02/01/2011
TX
Enumeration date
05/31/2006
Last updated
05/22/2013
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