Provider Demographics
NPI:1316984156
Name:STAATS, DEBBI L (PA-C)
Entity type:Individual
Prefix:
First Name:DEBBI
Middle Name:L
Last Name:STAATS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1813 W HARVARD AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2754
Mailing Address - Country:US
Mailing Address - Phone:541-440-6390
Mailing Address - Fax:541-440-6392
Practice Address - Street 1:783 W CENTRAL
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479-9472
Practice Address - Country:US
Practice Address - Phone:541-459-3500
Practice Address - Fax:541-459-4040
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORPA00645363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227616Medicaid
OR383846OtherMEDICARE RHC PROVIDER NUM
ORC91331OtherSUPERVISING MD'S UPIN