Individual
JONATHAN SIMON STAUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1202 MEDICAL CENTER DR, WILMINGTON, NC 28401-7307
(910) 341-3300
(910) 251-8896
Mailing address
1202 MEDICAL CENTER DR, WILMINGTON, NC 28401-7307
(910) 341-3300
(910) 251-8896
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
9400646
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110123217
RAILROAD MEDICARE
NC
01
—
79424
BCBS NC
NC
05
—
8979424
—
NC
Enumeration date
09/26/2006
Last updated
08/13/2014
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