Provider Demographics
NPI:1205512498
Name:STAATS, BRYANT
Entity type:Individual
Prefix:
First Name:BRYANT
Middle Name:
Last Name:STAATS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7757 CHADWICK RD
Mailing Address - Street 2:
Mailing Address - City:GAMBIER
Mailing Address - State:OH
Mailing Address - Zip Code:43022-9774
Mailing Address - Country:US
Mailing Address - Phone:567-333-1305
Mailing Address - Fax:
Practice Address - Street 1:7757 CHADWICK RD
Practice Address - Street 2:
Practice Address - City:GAMBIER
Practice Address - State:OH
Practice Address - Zip Code:43022-9774
Practice Address - Country:US
Practice Address - Phone:567-333-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor