Basic Information
Provider Information | |||||||||
NPI: | 1740710466 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STAYMAN | ||||||||
FirstName: | WILLIAM | ||||||||
MiddleName: | DOMINICK | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DPM | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 483 W SEED FARM RD | ||||||||
Address2: |   | ||||||||
City: | SACATON | ||||||||
State: | AZ | ||||||||
PostalCode: | 851475000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6075473476 | ||||||||
FaxNumber: | 6075476553 | ||||||||
Practice Location | |||||||||
Address1: | 1 ATWELL RD | ||||||||
Address2: |   | ||||||||
City: | COOPERSTOWN | ||||||||
State: | NY | ||||||||
PostalCode: | 133261301 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6075473476 | ||||||||
FaxNumber: | 6075476553 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/14/2017 | ||||||||
LastUpdateDate: | 01/12/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/12/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 007100 | NY | Y |   | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0103X | SC006849 | PA | N |   | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.