Provider Demographics
NPI:1912932476
Name:STAHL, MARK CLAYTON (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CLAYTON
Last Name:STAHL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14615 SAN PEDRO AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4316
Mailing Address - Country:US
Mailing Address - Phone:210-490-2051
Mailing Address - Fax:
Practice Address - Street 1:14615 SAN PEDRO AVE STE 250
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4316
Practice Address - Country:US
Practice Address - Phone:210-490-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.010391208000000X
TXP9742207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics