Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301094754 | MI |
NPI | 1063640530 |
---|---|
Provider Name | Dr. Robert Thomas Standring JR. |
First Address | Southfield, MI 48034-7648 |
Second Address | Southfield, MI 48034-7648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2009 |
Last Update Date | 08/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063640530 | (05) | MI |
4301094754 | LICENSE (01) | MI |