Provider Demographics
NPI:1043251036
Name:STAHELI, JAMES R (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:STAHELI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1910 S 72ND ST
Mailing Address - Street 2:STE 302
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1734
Mailing Address - Country:US
Mailing Address - Phone:402-391-2635
Mailing Address - Fax:402-391-0326
Practice Address - Street 1:4300 W MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1313
Practice Address - Country:US
Practice Address - Phone:334-446-0076
Practice Address - Fax:334-446-0203
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4327207Q00000X
NE266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDO1460OtherSTATE LICENSE
AL168373Medicaid
ALDO1460OtherSTATE LICENSE