Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | G4437 | TX |
N | 207VX0000X | Obstetrician | G4437 | TX |
NPI | 1407823214 |
---|---|
Provider Name | Dr. Robert L Stockburger |
First Address | Kerrville, TX 78029-0538 |
Second Address | Mexia, TX 76667-3620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 16/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0047PJ | BCBS (01) | TX |
A67707 | (02) | TX |