Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 21464 | IA |
NPI | 1013900844 |
---|---|
Provider Name | Jeffrey D Stahl |
First Address | West Des Moines, IA 50266-1900 |
Second Address | West Des Moines, IA 50266-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 18/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110076158 | RAILROAD MEDICARE (01) | IA |
13451 | BCBS (01) | IA |
2157859 | (05) | IA |
A01371 | (02) |