Healthcare Provider Details

I. General information

NPI: 1548286123
Provider Name (Legal Business Name): DAVID LAWRENCE STALEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DR
HUNTINGTON WV
25704-9300
US

IV. Provider business mailing address

1540 SPRING VALLEY DR
HUNTINGTON WV
25704-9300
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6755
  • Fax:
Mailing address:
  • Phone: 304-429-6755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR5B30
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: