Provider Demographics
NPI:1669423018
Name:STAEBEL, CRAIG ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALLEN
Last Name:STAEBEL
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 1:950 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
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3142208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH47722Medicare UPIN
TX8F3826Medicare ID - Type Unspecified