Organization
STEFAN P. THIELE, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEFAN PETER THIELE M.D. (PRESIDENT)
(903) 595-0105
Entity
Organization
Contact information
Practice address
1320 DOCTORS DR, TYLER, TX 75701-2262
(903) 595-0105
(903) 595-0103
Mailing address
1320 DOCTORS DR, TYLER, TX 75701-2262
(903) 595-0105
(903) 595-0103
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
L4756
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8600B9
MEDICARE GROUP
TX
Enumeration date
07/26/2007
Last updated
07/26/2007
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