Individual
JESSE W STAGGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3615 NW SAMARITAN DR STE 210, CORVALLIS, OR 97330-3771
(541) 768-4501
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0004251
CO
363A00000X
Physician Assistant
LL17393
OR
363A00000X
Physician Assistant
Primary
PA01277
OR
Other
Enumeration date
09/07/2007
Last updated
11/11/2020
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