Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 13715 | MO |
NPI | 1083688105 |
---|---|
Provider Name | Alan M. Stoll X |
First Address | Hannibal, MO 63401 |
Second Address | Hannibal, MO 63401-2257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T71043 | (02) | MO |