Provider Demographics
NPI:1467482638
Name:STAHL, MARLIN GERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLIN
Middle Name:GERALD
Last Name:STAHL
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 1:2500 BELLEVUE MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1591
Mailing Address - Country:US
Mailing Address - Phone:402-736-3709
Mailing Address - Fax:
Practice Address - Street 1:2500 BELLEVUE MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1591
Practice Address - Country:US
Practice Address - Phone:402-736-3709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15067207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB68058Medicare UPIN