Provider Demographics
NPI:1528017308
Name:STAHL, ALLAN JEFFREY
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:JEFFREY
Last Name:STAHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0514
Mailing Address - Country:US
Mailing Address - Phone:702-765-5793
Mailing Address - Fax:702-254-0013
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-765-5793
Practice Address - Fax:702-254-0013
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6419207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019495Medicaid
NV002019495Medicaid
NVD77022Medicare UPIN