Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | P-89 | ID |
NPI | 1003951401 |
---|---|
Provider Name | Dr. Stanley G. Eto |
First Address | Caldwell, ID 83605-4731 |
Second Address | Caldwell, ID 83605-4731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T44252 | (02) | ID |