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General NPI Number Information
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NPI Number | 1205879269
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Entity Type | Individual
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Provider Name | PATRICIA K STAGG M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 1287 FULTON RD ST JOSEPH'S URGENT CARE - FULTON CAMPUS
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City | SANTA ROSA
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State | CA
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Zip | 95401-4923
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Country | US
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Telephone | 707-543-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 160 WINDING WAY ST
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City | ANGWIN
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State | CA
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Zip | 94508-9656
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G83080
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License Number State | CA
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