Provider Demographics
NPI:1982654216
Name:STAGER, DAVID RICHARD JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
Last Name:STAGER
Suffix:JR
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 1:3801 W 15TH ST
Mailing Address - Street 2:A110
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4737
Mailing Address - Country:US
Mailing Address - Phone:972-758-0625
Mailing Address - Fax:972-964-5725
Practice Address - Street 1:3801 W 15TH ST
Practice Address - Street 2:A110
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4737
Practice Address - Country:US
Practice Address - Phone:972-758-0625
Practice Address - Fax:972-964-5725
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1572207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129544606Medicaid
TX129544605Medicaid
TX88064BMedicare PIN
TX129544606Medicaid