Provider Demographics
NPI:1689742181
Name:STAUBER, MARTIN H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:H
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 1:16611 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:714-528-7315
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:714-528-7315
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61573207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF35488Medicare UPIN
CAG61573Medicare PIN