Provider Demographics
NPI:1881653749
Name:STAHEL, EDWARD E JR (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:E
Last Name:STAHEL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1101 AUDUBON AVE
Mailing Address - Street 2:SUITE N5
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4957
Mailing Address - Country:US
Mailing Address - Phone:985-446-0506
Mailing Address - Fax:985-446-7614
Practice Address - Street 1:1101 AUDUBON AVE
Practice Address - Street 2:SUITE N5
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4957
Practice Address - Country:US
Practice Address - Phone:985-446-0506
Practice Address - Fax:985-446-7614
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2012-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS15827207W00000X
LA011264207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119257Medicaid
LA1316695Medicaid
MS00119257Medicaid
MSB65937Medicare UPIN
LA55970Medicare PIN