Theodore E. Staahl MD Inc

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

G37452 Issued in CA

Legal business name

THEODORE E. STAAHL MD INC

Practice address

1329 Spanos CT
Suite a-1
Modesto, CA 95355-2806

Phone

(209) 577-5700

Fax

(209) 577-5968

NPI assigned

Aug 12, 2010

Last updated

Nov 9, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Nancy Staahl

Title

Administrator/Office Manager

Phone

(209) 577-5700

Specialties & licenses 1

Addresses

Other names 1

• MD Laser Center Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1281571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667952000000",
    "number": "1467767541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1329 SPANOS CT",
            "address_2": "SUITE A-1",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552806",
            "telephone_number": "209-577-5700",
            "fax_number": "209-577-5968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1329 SPANOS CT",
            "address_2": "SUITE A-1",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953552806",
            "telephone_number": "209-577-5700",
            "fax_number": "209-577-5968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORE E. STAAHL MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-12",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A",
        "authorized_official_last_name": "STAAHL",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "ADMINISTRATOR/OFFICE MANAGER",
        "authorized_official_telephone_number": "209-577-5700",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CA",
            "license": "G37452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MD Laser Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "MD Laser Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Medical Specialty Clinic/Center in Modesto, CA
• Providers in Modesto, CA by specialty
• Medical Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.