Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 0101252155 | VA |
NPI | 1043461064 |
---|---|
Provider Name | Dr. Brian Carr Stisser |
First Address | Fishersville, VA 22939-2273 |
Second Address | Fishersville, VA 22939-2273 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2008 |
Last Update Date | 26/06/2012 |