Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | S5783 | TX |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | S5783 | TX |
NPI | 1376962530 |
---|---|
Provider Name | Drew Nathaniel Stal |
First Address | Arlington, TX 76012-2579 |
Second Address | Arlington, TX 76012-2579 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 13/08/2020 |