Basic Information
| Provider Information | |||||||||
| NPI: | 1164675088 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JENNIFER L. STAUD M.D.P.A. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | JENNIFER L.STAUD M.D.P.A. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 TUSCAN | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750393834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724013200 | ||||||||
| FaxNumber: | 9724013230 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 TUSCAN | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750393834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724013200 | ||||||||
| FaxNumber: | 9724013230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2008 | ||||||||
| LastUpdateDate: | 10/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | STAUD | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | LEIGH | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 9724013200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D.P.A. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | M2827 | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.