Individual
SAMUEL JONAS STAGG III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
225 DUNN ST, HOUMA, LA 70360-4413
(985) 876-0300
(985) 872-0317
Mailing address
PO BOX 4176, HOUMA, LA 70361-4176
(985) 876-0300
(985) 872-0317
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
06297R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060042306
RR MEDICARE
LA
05
—
1343901
—
LA
Enumeration date
07/07/2005
Last updated
10/19/2015
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