Provider Demographics
NPI:1174608335
Name:STADTLER, LINDSAY W (MD)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:W
Last Name:STADTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:6210 JOHN RYAN DR
Practice Address - Street 2:STE 104
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4113
Practice Address - Country:US
Practice Address - Phone:817-294-7578
Practice Address - Fax:817-294-0585
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6188208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162742401Medicaid
1750369203OtherGRP NPI NUMBER
TX2360144OtherUHC PIN
TXSTAL058704OtherCCHIP PIN
TX00U87ZOtherBCSTX GRP PIN
TX140442852Medicaid
TX8K3191OtherBCBSTX IND PIN
TX140442893Medicaid
TX2146971OtherFIRSTHEATLH PIN
TX7489549OtherAETNA PIN
TX140442893Medicaid
TX7489549OtherAETNA PIN
TX2360144OtherUHC PIN