Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC004138L | PA |
Y | 222Z00000X | Podiatrist | SC004138L | PA |
N | 213ES0103X | Foot & Ankle Surgery | SC004138L | PA |
NPI | 1023101169 |
---|---|
Provider Name | Brian G Stahl |
First Address | Easton, PA 18045-8001 |
Second Address | Easton, PA 18045-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 02/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00972929 | RAILROAD MEDICARE (01) | PA |
U65370 | (02) | PA |