Provider Demographics
NPI:1912582180
Name:STAUFERT, JESUS MIGUEL JR (MT)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:MIGUEL
Last Name:STAUFERT
Suffix:JR
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9216 ROANOKE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-7454
Mailing Address - Country:US
Mailing Address - Phone:915-227-4718
Mailing Address - Fax:
Practice Address - Street 1:9216 ROANOKE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-7454
Practice Address - Country:US
Practice Address - Phone:915-227-4718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT-213250246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist