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Provider Information for 1497934897


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STEPHEN MICHAEL WAHL M.D.


Gender: Male

NPI: 1497934897
Last Updated: 2018-09-19
Certification Date:

Details

NameValue
NPI1497934897
Enumeration Date2007-11-01
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 265 N BINKLEY ST
SOLDOTNA, AK 99669-7523
United States

Phone: 907-262-9341 | Fax:907-262-1545
 
Primary Practice Address 265 N BINKLEY ST
SOLDOTNA, AK 99669-7523
United States

Phone: 907-262-9341 | Fax:907-262-1545
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDAKMD 3683
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 207P00000X - Emergency Medicine AKAA 3683
Yes 207Q00000X - Family Medicine AKAA 3683
No 333600000X - Pharmacy