Provider Demographics
NPI:1679761209
Name:MARTIN STAUBER MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MARTIN STAUBER MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:STAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-528-8670
Mailing Address - Street 1:16611 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2046
Mailing Address - Country:US
Mailing Address - Phone:714-528-8670
Mailing Address - Fax:
Practice Address - Street 1:16611 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2046
Practice Address - Country:US
Practice Address - Phone:714-528-8670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61573207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG61573Medicare PIN
CAF35488Medicare UPIN