Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 22706 | TX |
N | 1223E0200X | Endodontist | 4789791-9921 | UT |
NPI | 1023078284 |
---|---|
Provider Name | Charles Hillam Stuart |
First Address | El Paso, TX 79912-1854 |
Second Address | El Paso, TX 79912-3611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 08/07/2007 |