Provider Demographics
NPI:1013012491
Name:STANGL, JOSEPH A (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:STANGL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2159
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2159
Mailing Address - Country:US
Mailing Address - Phone:402-280-3550
Mailing Address - Fax:
Practice Address - Street 1:3802 RAYNOR PKWY
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-6048
Practice Address - Country:US
Practice Address - Phone:402-280-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE415363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE272872Medicare ID - Type UnspecifiedMEDICARE