Provider Demographics
NPI:1700884921
Name:STAYMAN, J WEBSTER III (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:WEBSTER
Last Name:STAYMAN
Suffix:III
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 1:460 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2027
Mailing Address - Country:US
Mailing Address - Phone:607-432-4477
Mailing Address - Fax:607-432-1184
Practice Address - Street 1:460 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2027
Practice Address - Country:US
Practice Address - Phone:607-432-4477
Practice Address - Fax:607-432-1184
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126764-1208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
242002305OtherTRAVELERS RAILROAD MEDICA
10032783OtherCDPHP
NYD74005Medicare UPIN
NY53214AMedicare PIN