Individual
DOUGLAS L STAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
775 POLE LINE RD W, SUITE 101, TWIN FALLS, ID 83301-5814
(208) 814-8100
(208) 814-8900
Mailing address
PO BOX 587, SUITE 100, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
M3528
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003949000
—
ID
Enumeration date
06/26/2006
Last updated
09/06/2012
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