Provider Demographics
NPI:1164248696
Name:STOHEL, THOMAS DAVID
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DAVID
Last Name:STOHEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5439 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:IONA
Mailing Address - State:ID
Mailing Address - Zip Code:83427-4914
Mailing Address - Country:US
Mailing Address - Phone:801-624-0111
Mailing Address - Fax:
Practice Address - Street 1:5439 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:IONA
Practice Address - State:ID
Practice Address - Zip Code:83427-4914
Practice Address - Country:US
Practice Address - Phone:801-624-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
W58625171400000X
ID5061875175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach