Provider Demographics
NPI:1538144407
Name:STAGER, WILLIAM HARRY (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HARRY
Last Name:STAGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 GOLF RD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-5509
Mailing Address - Country:US
Mailing Address - Phone:561-832-1894
Mailing Address - Fax:561-832-1590
Practice Address - Street 1:311 GOLF RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-5509
Practice Address - Country:US
Practice Address - Phone:561-832-1894
Practice Address - Fax:561-832-1590
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5916204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS5916OtherLICENSE
FL80360Medicare ID - Type Unspecified
FLF22128Medicare UPIN