Individual
JONATHAN PATRICK STAIDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4814 SPARKS BLVD, SPARKS, NV 89436-8219
(775) 327-0699
(775) 451-7501
Mailing address
640 W MOANA LN, RENO, NV 89509-4903
(775) 324-0699
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
35-126612
OH
207ND0101X
MOHS-Micrographic Surgery Physician
MD457066
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0129749
—
OH
Enumeration date
04/18/2011
Last updated
01/19/2021
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