Provider Demographics
NPI:1457351363
Name:STATEN, STEPHEN FRANCIS (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FRANCIS
Last Name:STATEN
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 1:4438 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3316
Mailing Address - Country:US
Mailing Address - Phone:314-543-5996
Mailing Address - Fax:314-543-5958
Practice Address - Street 1:4438 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3316
Practice Address - Country:US
Practice Address - Phone:314-543-5996
Practice Address - Fax:314-543-5958
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2E40207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203000179Medicaid
MOC48429Medicare UPIN
MO203000179Medicaid
MO011013663Medicare ID - Type Unspecified