MEDICARE: C RICHARD STASNEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	D6183	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B158353	OTHER	TX	MEDICARE ID NUMBER

General Provider Information

NPI Number	:	1447245709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	C RICHARD STASNEY MD

Provider Business Mailing Address
First Line	:	6550 FANNIN ST
Second Line	:	STE 2025
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-796-2181
Fax Number	:	713-796-2349

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST
Second Line	:	STE 2025
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-796-2181
Fax Number	:	713-796-2349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	10/24/2012

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