Provider Demographics
NPI:1952393951
Name:STAGGERS, WILLIAM RUCKER
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RUCKER
Last Name:STAGGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 THOUSAND OAKS DR STE 294
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3563
Mailing Address - Country:US
Mailing Address - Phone:210-494-1100
Mailing Address - Fax:210-494-1117
Practice Address - Street 1:411 N SECTION ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2649
Practice Address - Country:US
Practice Address - Phone:251-928-9090
Practice Address - Fax:251-990-0520
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15283208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF75443Medicare UPIN