Basic Information
| Provider Information | |||||||||
| NPI: | 1548461346 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEHR | ||||||||
| FirstName: | WOLFGANG | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 744 52ND ST | ||||||||
| Address2: | SUITE 4100 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946091810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104283022 | ||||||||
| FaxNumber: | 5104283405 | ||||||||
| Practice Location | |||||||||
| Address1: | 744 52ND ST | ||||||||
| Address2: | SUITE 4100 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946091810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104283022 | ||||||||
| FaxNumber: | 5104283405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2007 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | C54296 | CA | N | Other Service Providers | Specialist | 208600000X | C54296 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0120X | MD2016-0814 | NM | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | C54296 | CA | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 19504 | NV | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
ID Information
| ID | Type | State | Issuer | Description | 12146131 | 01 | NV | CAQH | OTHER | 19504 | 01 | NV | MD NEVADA | OTHER | C54296 | 01 | CA | MD CALI | OTHER |