Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 35047100 | OH |
Y | 208600000X | Surgeon | 35047100 | OH |
NPI | 1003896168 |
---|---|
Provider Name | David L Stanbery |
First Address | Willard, OH 44890-1656 |
Second Address | Willard, OH 44890-1656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 07/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020000971 | RR MEDICARE (01) | |
0480055 | (05) | OH |
A15061 | (02) |