Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD29181 | OR |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | N6679 | TX |
NPI | 1346424835 |
---|---|
Provider Name | Dr. Christian L Stallworth |
First Address | San Antonio, TX 78240-1670 |
Second Address | San Antonio, TX 78229-3931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2007 |
Last Update Date | 22/09/2021 |