Healthcare Provider Details

I. General information

NPI: 1619977758
Provider Name (Legal Business Name): STANLEY HAHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 KENTUCKY AVE SUITE 102
PADUCAH KY
42003-3817
US

IV. Provider business mailing address

2605 KENTUCKY AVE SUITE 306
PADUCAH KY
42003-3800
US

V. Phone/Fax

Practice location:
  • Phone: 270-575-8462
  • Fax: 270-443-0235
Mailing address:
  • Phone: 270-415-7653
  • Fax: 270-575-8359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberK2480
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA50820
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number53314
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number28755
License Number StateIA
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2023020091
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: