Provider Demographics
NPI:1356551279
Name:STAGGS, DEACON WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:DEACON
Middle Name:WAYNE
Last Name:STAGGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1776 WOODSTEAD CT
Mailing Address - Street 2:STE 208
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1480
Mailing Address - Country:US
Mailing Address - Phone:281-724-3050
Mailing Address - Fax:281-724-3100
Practice Address - Street 1:1776 WOODSTEAD CT
Practice Address - Street 2:STE 208
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1480
Practice Address - Country:US
Practice Address - Phone:512-382-4664
Practice Address - Fax:512-266-5601
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9675208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198193802Medicaid
TX8BR156OtherBCBS
TX198193801Medicaid
TXP00696103Medicare PIN
TX8L3045Medicare PIN
TX8BR156OtherBCBS