Provider Demographics
NPI:1346354941
Name:STAGGEMEIER, DALE AUGUST JR (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:AUGUST
Last Name:STAGGEMEIER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2048
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951
Mailing Address - Country:US
Mailing Address - Phone:409-489-8938
Mailing Address - Fax:251-260-8205
Practice Address - Street 1:205 E LAVIELLE ST
Practice Address - Street 2:
Practice Address - City:KIRBYVILLE
Practice Address - State:TX
Practice Address - Zip Code:75956
Practice Address - Country:US
Practice Address - Phone:409-489-8938
Practice Address - Fax:251-260-8205
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM0627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11609982OtherCAQH NUMBER
TX175132303Medicaid
11609982OtherCAQH NUMBER
8G2821Medicare ID - Type Unspecified