Healthcare Provider Details

I. General information

NPI: 1548461346
Provider Name (Legal Business Name): WOLFGANG STEHR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 52ND ST SUITE 4100
OAKLAND CA
94609-1810
US

IV. Provider business mailing address

744 52ND ST SUITE 4100
OAKLAND CA
94609-1810
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3022
  • Fax: 510-428-3405
Mailing address:
  • Phone: 510-428-3022
  • Fax: 510-428-3405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberC54296
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number19504
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC54296
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC54296
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD2016-0814
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: