Healthcare Provider Details

I. General information

NPI: 1053350082
Provider Name (Legal Business Name): KENT STAHL, DPM, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 MUELA CREEK DR STE C
BEAUMONT TX
77706-1501
US

IV. Provider business mailing address

6115 MUELA CREEK DR STE C
BEAUMONT TX
77706-1501
US

V. Phone/Fax

Practice location:
  • Phone: 409-242-1989
  • Fax: 409-242-1847
Mailing address:
  • Phone: 409-242-1989
  • Fax: 409-242-1847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1748
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENT E STAHL
Title or Position: OWNER/PRESIDENT
Credential: DPM
Phone: 409-242-1989