Provider Demographics
NPI:1386683183
Name:STAHL, KENT E (DPM)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:E
Last Name:STAHL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S TWIN CITY HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-4246
Mailing Address - Country:US
Mailing Address - Phone:409-727-1773
Mailing Address - Fax:409-727-1433
Practice Address - Street 1:520 S TWIN CITY HWY STE 102
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-4246
Practice Address - Country:US
Practice Address - Phone:409-727-1773
Practice Address - Fax:409-727-1433
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1748213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
5757850001Medicare NSC
TX8F3064Medicare PIN
TXV09374Medicare UPIN