Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2187 | AL |
N | 2084N0402X | Child Neurologist | 2187 | AL |
NPI | 1255727145 |
---|---|
Provider Name | Anthony Staples |
First Address | Birmingham, AL 35233-1711 |
Second Address | Roanoke, VA 24018-0720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 13/10/2021 |