Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 21708 | SC |
Y | 207RI0011X | Interventional Cardiology | 21708 | SC |
NPI | 1093791071 |
---|---|
Provider Name | Brett C Stoll |
First Address | Columbia, SC 29202-3174 |
Second Address | Anderson, SC 29621-7915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 03/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
217081 | (05) | SC |
G51077 | (02) | SC |
P00970781 | RR MEDICARE (01) | SC |