Provider Demographics
NPI:1265472708
Name:STAIRS, BRIAN J (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:STAIRS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:506 ATHENA DR
Mailing Address - Street 2:PO BOX 98
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1005
Mailing Address - Country:US
Mailing Address - Phone:724-468-6869
Mailing Address - Fax:724-468-6207
Practice Address - Street 1:1007 COURT YARD PLZ
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1838
Practice Address - Country:US
Practice Address - Phone:724-539-8517
Practice Address - Fax:724-879-8024
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010748L207N00000X
PAOS-010748-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00189282OtherRR MEDICARE
PA001409786OtherHIGHMARK
6220124OtherCIGNA
PA165607OtherMEDPLUS/UNISON
PA171447OtherMEDICARE
PA0019118590005Medicaid
PA410485OtherUPMC
PA410485OtherUPMC