Provider Demographics
NPI:1952318271
Name:STAHL, RAY EMERSON JR (MD)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:EMERSON
Last Name:STAHL
Suffix:JR
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 1:901 BURNETT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2908
Mailing Address - Country:US
Mailing Address - Phone:870-425-9120
Mailing Address - Fax:870-424-4470
Practice Address - Street 1:901 BURNETT DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2908
Practice Address - Country:US
Practice Address - Phone:870-425-9120
Practice Address - Fax:870-424-4470
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR2766208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101035001Medicaid
AR101035001Medicaid
D04929Medicare UPIN