Basic Information
| Provider Information | |||||||||
| NPI: | 1356551279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAGGS | ||||||||
| FirstName: | DEACON | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1776 WOODSTEAD CT | ||||||||
| Address2: | STE 208 | ||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773801480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817243050 | ||||||||
| FaxNumber: | 2817243100 | ||||||||
| Practice Location | |||||||||
| Address1: | 1776 WOODSTEAD CT | ||||||||
| Address2: | STE 208 | ||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773801480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123824664 | ||||||||
| FaxNumber: | 5122665601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 10/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | M9675 | TX | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 198193802 | 05 | TX | MEDICAID | 8BR156 | 01 | TX | BCBS | OTHER | 198193801 | 05 | TX | MEDICAID |