Provider Demographics
NPI:1053350082
Name:KENT STAHL, DPM, PLLC
Entity type:Organization
Organization Name:KENT STAHL, DPM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:409-242-1989
Mailing Address - Street 1:6115 MUELA CREEK DR STE C
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-1501
Mailing Address - Country:US
Mailing Address - Phone:409-242-1989
Mailing Address - Fax:409-242-1847
Practice Address - Street 1:6115 MUELA CREEK DR STE C
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-1501
Practice Address - Country:US
Practice Address - Phone:409-242-1989
Practice Address - Fax:409-242-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1748213ES0103X
213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV09374Medicare UPIN
5757850001Medicare NSC
TX00W547Medicare PIN