MEDICARE: DR. BRIAN RAY STAHL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	35-05-9013-S	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942202700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN RAY STAHL M.D.

Provider Business Mailing Address
First Line	:	4235 INDIAN RIPPLE RD
Second Line	:	STE 100
City	:	BEAVERCREEK
State	:	OH
Zip	:	45440-3247
Country	:	US
Telephone Number	:	937-427-2020
Fax Number	:	937-429-1144

Provider Business Practice Location Address
First Line	:	4235 INDIAN RIPPLE RD
Second Line	:	STE 100
City	:	BEAVERCREEK
State	:	OH
Zip	:	45440-3247
Country	:	US
Telephone Number	:	937-427-2020
Fax Number	:	937-429-1144

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	06/20/2011

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