Individual
DR. BRUCE WAYNE STAEHELI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
119 CLUBHOUSE PL, ELK CITY, OK 73644-7301
(580) 303-4664
Mailing address
PO BOX 2467, ELK CITY, OK 73648-2467
(580) 303-4664
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35 072661
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000381808
ANTHEM
OH
01
—
000000561000
ANTHEM
OH
01
—
1062641
WV DWC
WV
05
—
2015698
—
OH
05
—
3810012159
—
WV
Enumeration date
03/12/2007
Last updated
09/16/2008
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