Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 11595 | TX |
NPI | 1134238009 |
---|---|
Provider Name | Dr. Robert Page Stites |
First Address | Lubbock, TX 79414-5004 |
Second Address | Lubbock, TX 79414-5004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |