Provider Demographics
NPI:1396963906
Name:STAUCH, DOUGLAS MARTIN (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MARTIN
Last Name:STAUCH
Suffix:
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 1:4707 PIN OAK PARK APT 714
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2254
Mailing Address - Country:US
Mailing Address - Phone:713-218-6651
Mailing Address - Fax:
Practice Address - Street 1:4707 PIN OAK PARK APT 714
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2254
Practice Address - Country:US
Practice Address - Phone:713-218-6651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist