Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME115779 | FL |
Y | 111NI0900X | Internist | ME115779 | FL |
NPI | 1003086778 |
---|---|
Provider Name | Dr. Stalin R Subramanian |
First Address | Fort Sam Houston, TX 78234-4504 |
Second Address | Fort Sam Houston, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2008 |
Last Update Date | 15/12/2015 |