Staley, Jerry T

Staley, Jerry T is an individual health care provider with primary practice located at 55 Middle St , Augusta ME 04330-5728. He recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as his primary health care specialty. Staley, Jerry T can be contacted via phone (207) 629-9488.

Contact Information

Primary practice address
55 Middle St Augusta ME 04330-5728
Phone: (207) 629-9488
Fax: (207) 622-8796
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 2002023337 Missouri

Profile Details

NPI number 1144256843
LBN Legal business name Staley, Jerry T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 24th, 2006
Last updated Nov 6th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144256843 NPPES
Missouri Other P00283188 RR MEDICARE

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