Basic Information
| Provider Information | |||||||||
| NPI: | 1174608335 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STADTLER | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 6210 JOHN RYAN DR | ||||||||
| Address2: | STE 104 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761324113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172947578 | ||||||||
| FaxNumber: | 8172940585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 04/20/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | L6188 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 162742401 | 05 | TX | MEDICAID | 1750369203 | 01 | GRP NPI NUMBER | OTHER | 2360144 | 01 | TX | UHC PIN | OTHER | STAL058704 | 01 | TX | CCHIP PIN | OTHER | 00U87Z | 01 | TX | BCSTX GRP PIN | OTHER | 140442852 | 05 | TX | MEDICAID | 8K3191 | 01 | TX | BCBSTX IND PIN | OTHER | 140442893 | 05 | TX | MEDICAID | 2146971 | 01 | TX | FIRSTHEATLH PIN | OTHER | 7489549 | 01 | TX | AETNA PIN | OTHER |