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Individual

DR. EARL RAY STAGG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2800 1ST AVE, SUITE C, LAKE CHARLES, LA 70601-8884
(337) 491-9880
(337) 433-3268
Mailing address
2800 1ST AVE, SUITE C, LAKE CHARLES, LA 70601-8884
(337) 491-9880
(337) 433-3268

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD010857
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1133663
LA
01
55502CE16
MEDICARE ID
LA
Enumeration date
07/28/2005
Last updated
11/14/2016
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