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Individual

GUSTAV E STAAHL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
(701) 364-8078
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
26153
MN
207L00000X
Anesthesiology Physician
Primary
4003
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
12404
ND
01
142067
UCARE #
ND
01
1619
NDBS #
ND
01
19418ST
MNBS #
ND
01
2000709
MEDICA #
ND
01
2000710
MEDICA #
ND
01
3535
SIOUX VALLEY #
ND
01
4F458ST
MNBS #
MN
01
676652
AMERICA'S PPO/ARAZ #
ND
05
860790700
ND
01
DA9011015591
PREFERRED ONE #
ND
01
HP38335
HEALTHPARTNERS #
ND
01
ND200063
LHS #
ND
Enumeration date
07/05/2006
Last updated
07/13/2012
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