Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 1911241 | NY |
NPI | 1033103478 |
---|---|
Provider Name | Dr. Philip John Stuart |
First Address | Elmira, NY 14901-3230 |
Second Address | Elmira, NY 14905-2220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 23/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000004938 | BCBS (01) | |
01412835 | (05) | NY |
F46442 | (02) |