Provider Demographics
NPI:1649400391
Name:BENJAMIN ADAM STAHL M.D. P.A.
Entity Type:Organization
Organization Name:BENJAMIN ADAM STAHL M.D. P.A.
Other - Org Name:BOERNE FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-331-8585
Mailing Address - Street 1:112 HERFF RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2751
Mailing Address - Country:US
Mailing Address - Phone:830-331-8585
Mailing Address - Fax:830-331-8586
Practice Address - Street 1:112 HERFF RD STE 110
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2751
Practice Address - Country:US
Practice Address - Phone:830-331-8585
Practice Address - Fax:830-331-8586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012087660Medicaid
TX0A5277Medicare PIN