Provider Demographics
NPI:1073576328
Name:STABEL, JOHN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:STABEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 FOREST AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7680
Mailing Address - Country:US
Mailing Address - Phone:530-892-4815
Mailing Address - Fax:530-892-4816
Practice Address - Street 1:2109 FOREST AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7680
Practice Address - Country:US
Practice Address - Phone:530-892-4815
Practice Address - Fax:530-892-4816
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85443207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G854430Medicaid
CAG29811Medicare UPIN
CA00G854430Medicaid