Provider Demographics
NPI:1225212251
Name:PAUL ERIC STOUFFLET
Entity Type:Organization
Organization Name:PAUL ERIC STOUFFLET
Other - Org Name:WESTLAKE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:STOUFFLET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-380-9441
Mailing Address - Street 1:PO BOX 90969
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-0969
Mailing Address - Country:US
Mailing Address - Phone:512-828-6959
Mailing Address - Fax:512-698-5215
Practice Address - Street 1:715 W 34TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1223
Practice Address - Country:US
Practice Address - Phone:512-380-9441
Practice Address - Fax:512-380-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8440261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
83980NMedicare PIN
G31223Medicare UPIN