Provider Demographics
NPI:1942202700
Name:STAHL, BRIAN RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RAY
Last Name:STAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4235 INDIAN RIPPLE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3247
Mailing Address - Country:US
Mailing Address - Phone:937-427-2020
Mailing Address - Fax:937-429-1144
Practice Address - Street 1:4235 INDIAN RIPPLE RD
Practice Address - Street 2:STE 100
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3247
Practice Address - Country:US
Practice Address - Phone:937-427-2020
Practice Address - Fax:937-429-1144
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-9013-S207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0875361Medicaid
OH0875361Medicaid
OH180041327Medicare PIN
OH0774182Medicare PIN