Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | J6747 | TX |
NPI | 1104834340 |
---|---|
Provider Name | Dr. Brian Wayne Stigall |
First Address | New Braunfels, TX 78130-6114 |
Second Address | New Braunfels, TX 78130-6114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 11/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1G9877 | MEDICARE (01) | TX |
8876N0 | MEDICARE ID (01) | TX |
8C0650 | BCBS (01) | TX |
DD9763 | MEDICARE RAILROAD (01) | TX |
F99530 | (02) | TX |
J6747 | LICENSE (01) | TX |
P02569513 | MEDICARE RAILROAD (01) | TX |