Healthcare Provider Details

I. General information

NPI: 1295651982
Provider Name (Legal Business Name): BRETT DALE STALLBAUMER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 SW MULVANE ST
TOPEKA KS
66606-1764
US

IV. Provider business mailing address

823 SW MULVANE ST
TOPEKA KS
66606-1764
US

V. Phone/Fax

Practice location:
  • Phone: 785-270-4355
  • Fax: 785-270-4364
Mailing address:
  • Phone: 785-270-4355
  • Fax: 785-270-4364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-03352
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: