Individual
PAUL T STALLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 JAMES WAY, SUITE 203, PISMO BEACH, CA 93449-4973
(805) 481-3733
(805) 489-7376
Mailing address
2 JAMES WAY, SUITE 203, PISMO BEACH, CA 93449-4973
(805) 481-3733
(805) 489-7376
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
G81743
CA
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
G81743
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G817430
BLUE SHIELD OF CALIFORNIA
CA
01
—
G81743
BLUE CROSS
CA
Enumeration date
11/09/2005
Last updated
10/18/2017
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