Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | F4575 | TX |
NPI | 1003890468 |
---|---|
Provider Name | Bonnie S Stump |
First Address | Georgetown, TX 78626-7728 |
Second Address | Georgetown, TX 78626-7728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 29/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B26756 | (02) |