Healthcare Provider Details

I. General information

NPI: 1497934897
Provider Name (Legal Business Name): STEPHEN MICHAEL WAHL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 N BINKLEY ST
SOLDOTNA AK
99669-7523
US

IV. Provider business mailing address

265 N BINKLEY ST
SOLDOTNA AK
99669-7523
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-9341
  • Fax: 907-262-1545
Mailing address:
  • Phone: 907-262-9341
  • Fax: 907-262-1545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberAA 3683
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAA 3683
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: