Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 298 | OK |
Y | 222Z00000X | Podiatrist | 298 | OK |
NPI | 1003043423 |
---|---|
Provider Name | Dr. James Daniel Stough |
First Address | Malvern, PA 19355-0746 |
Second Address | Enid, OK 73701-5712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2009 |
Last Update Date | 19/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200445380A | (05) | OK |