Healthcare Provider Details

I. General information

NPI: 1023007101
Provider Name (Legal Business Name): RICHARD LEE STAHLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95TH MEDICAL GROUP 30 NIGHTINGALE RD
EDWARDS AFB CA
93524-0001
US

IV. Provider business mailing address

5320 PALO VERDE DR
EDWARDS CA
93523-2406
US

V. Phone/Fax

Practice location:
  • Phone: 661-275-2749
  • Fax: 661-275-4365
Mailing address:
  • Phone: 661-258-7219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3835A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: