Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 006698 | MO |
Y | 213ER0200X | Radiology | 006698 | MO |
NPI | 1922069830 |
---|---|
Provider Name | Dr. Benjamin Otto Stiles |
First Address | Independence, MO 64055-6904 |
Second Address | Independence, MO 64055-6904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 17/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30149013 | BCBS (01) | MO |
641510 | ACN (01) | MO |
7230398 | AETNA (01) | MO |
U90906 | (02) | MO |