MEDICARE: JAMES ALBERT STAAB 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	207P00000X	Emergency Medicine Physician	ME50493	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04496	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700865433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ALBERT STAAB MD

Provider Business Mailing Address
First Line	:	2901 NE 26TH PL
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306-1968
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 NE 26TH PLACE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33306
Country	:	US
Telephone Number	:	954-401-6198
Fax Number	:

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	11/20/2015

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