Healthcare Provider Details

I. General information

NPI: 1164248696
Provider Name (Legal Business Name): THOMAS DAVID STOHEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2024
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5439 BUCHANAN ST
IONA ID
83427-4914
US

IV. Provider business mailing address

5439 BUCHANAN ST
IONA ID
83427-4914
US

V. Phone/Fax

Practice location:
  • Phone: 801-624-0111
  • Fax:
Mailing address:
  • Phone: 801-624-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberW58625
License Number State
# 3
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number5061875
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: