Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 16399 | TX |
NPI | 1104908714 |
---|---|
Provider Name | Dr. Brian Douglas Stapp |
First Address | Houston, TX 77031-1923 |
Second Address | Houston, TX 77031-1923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16399 | STATE LICENSE # (01) | TX |
5395637 | AETNA PROVIDER ID# (01) | TX |
86D552 | BC/BS PROVIDER# (01) | TX |
U70881 | (02) | TX |