Healthcare Provider Details

I. General information

NPI: 1962452177
Provider Name (Legal Business Name): ROBERT SCOTT STALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PERDIDO ST
NEW ORLEANS LA
70112-1262
US

IV. Provider business mailing address

1010 SHORT ST APT. A
NEW ORLEANS LA
70118-2753
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-0811
  • Fax:
Mailing address:
  • Phone: 504-866-8807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD.200194
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: