Provider Demographics
NPI:1235113671
Name:STAUBER, MARSHALL E (MD)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:E
Last Name:STAUBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 WASHINGTON ST
Mailing Address - Street 2:STE 101
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8282
Mailing Address - Country:US
Mailing Address - Phone:954-272-2225
Mailing Address - Fax:954-272-0554
Practice Address - Street 1:3702 WASHINGTON ST
Practice Address - Street 2:STE 101
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8282
Practice Address - Country:US
Practice Address - Phone:954-272-2225
Practice Address - Fax:954-272-0554
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061689207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000385OtherAVMED
002329OtherNHP
000385OtherAVMED
17684PMedicare ID - Type Unspecified