Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 82-316 | NM |
Y | 213ES0000X | Sports Medicine | 82-316 | NM |
NPI | 1053327361 |
---|---|
Provider Name | Clifford R Stoller |
First Address | Albuquerque, NM 87109-2500 |
Second Address | Albuquerque, NM 87109-2500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000037341 | (05) | NM |
D35988 | (02) | NM |