Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 85-106 | NM |
NPI | 1003884818 |
---|---|
Provider Name | Dr. Phillip E Styka |
First Address | Albuquerque, NM 87190-0585 |
Second Address | Albuquerque, NM 87109-4327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 26/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34843 | (05) | NM |
C98126 | (02) | NM |