Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 3093873-9924 | UT |
N | 122300000X | Dentist | 5354 | AZ |
N | 1223D0004X | Dentist Anesthesiologist | 11707 | NC |
Y | 1223D0004X | Dentist Anesthesiologist | D5354 | AZ |
N | 207L00000X | Anesthesiologist | 11707 | NC |
NPI | 1629025259 |
---|---|
Provider Name | Dr. Chad Michael Stoker |
First Address | Mesa, AZ 85210-5030 |
Second Address | Phoenix, AZ 85023-6290 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 08/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
571887 | (05) | AZ |