Provider Demographics
NPI:1205887585
Name:CRAIG STAEBEL M.D., P.A.
Entity type:Organization
Organization Name:CRAIG STAEBEL M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:STAEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-686-1650
Mailing Address - Street 1:950 W UNIVERSITY AVE
Mailing Address - Street 2:BUILDING 2, SUITE 207
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6505
Mailing Address - Country:US
Mailing Address - Phone:512-686-1650
Mailing Address - Fax:512-686-1652
Practice Address - Street 1:950 W UNIVERSITY AVE
Practice Address - Street 2:BUILDING 2, SUITE 207
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6505
Practice Address - Country:US
Practice Address - Phone:512-686-1650
Practice Address - Fax:512-686-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3142208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH47722Medicare UPIN
TX00W958Medicare ID - Type UnspecifiedGROUP #