=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770166548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APEX ALLERGY AND ASTHMA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2021
-----------------------------------------------------
Last Update Date | 04/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14615 SAN PEDRO AVE STE 250
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78232-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-490-2051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14615 SAN PEDRO AVE STE 250
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78232-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-490-2051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARK C STAHL
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 210-490-2051
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------