Healthcare Provider Details

I. General information

NPI: 1053485359
Provider Name (Legal Business Name): RICHARD A. STAGLIANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 NW CLEARWATER DR STE 200
BEND OR
97703-9412
US

IV. Provider business mailing address

2900 NW CLEARWATER DR STE 200
BEND OR
97703-9412
US

V. Phone/Fax

Practice location:
  • Phone: 415-745-3305
  • Fax: 415-634-0285
Mailing address:
  • Phone: 415-745-3305
  • Fax: 415-634-0285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD196711
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: