Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | G48748 | CA |
NPI | 1326203605 |
---|---|
Provider Name | Daniel Maxwell Stuart |
First Address | Coronado, CA 92178-1888 |
Second Address | San Diego, CA 92121-3022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2008 |
Last Update Date | 04/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A51159 | (02) | CA |