Healthcare Provider Details

I. General information

NPI: 1578565222
Provider Name (Legal Business Name): A. JAY STAUB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8160 WALNUT HILL LN SUITE # 116
DALLAS TX
75231-4339
US

IV. Provider business mailing address

555 REPUBLIC DR SUITE # 460
PLANO TX
75074-5481
US

V. Phone/Fax

Practice location:
  • Phone: 214-365-1150
  • Fax: 214-363-2477
Mailing address:
  • Phone: 972-644-2819
  • Fax: 972-680-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberF4563
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: