Provider Demographics
NPI:1740710466
Name:STAYMAN, WILLIAM DOMINICK (DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DOMINICK
Last Name:STAYMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 W SEED FARM RD
Mailing Address - Street 2:
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85147-5000
Mailing Address - Country:US
Mailing Address - Phone:607-547-3476
Mailing Address - Fax:607-547-6553
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1301
Practice Address - Country:US
Practice Address - Phone:607-547-3476
Practice Address - Fax:607-547-6553
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007100213ES0103X
PASC006849213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery