MEDICARE: DR. ROBERT SCOTT STALL 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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	MD.200194	LA

General Provider Information

NPI Number	:	1962452177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT SCOTT STALL M.D.

Provider Business Mailing Address
First Line	:	1010 SHORT ST
Second Line	:	APT. A
City	:	NEW ORLEANS
State	:	LA
Zip	:	70118-2753
Country	:	US
Telephone Number	:	504-866-8807
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 PERDIDO ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-1262
Country	:	US
Telephone Number	:	504-568-0811
Fax Number	:

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/08/2007

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