Healthcare Provider Details

I. General information

NPI: 1003843038
Provider Name (Legal Business Name): STEPHEN MARSHALL WAHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 BEE RIDGE RD BUILDING F, SUITE B
SARASOTA FL
34233-1207
US

IV. Provider business mailing address

3920 BEE RIDGE RD BUILDING F, SUITE B
SARASOTA FL
34233-1207
US

V. Phone/Fax

Practice location:
  • Phone: 941-923-5491
  • Fax: 941-924-4751
Mailing address:
  • Phone: 941-923-5491
  • Fax: 941-924-4751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberME66624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: