Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2628 | VA |
NPI | 1023046919 |
---|---|
Provider Name | Dr. Stephen L Bissell |
First Address | Chester, VA 23831 |
Second Address | Chester, VA 23831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005296 | ANTHEM BCBS (01) | |
024247 | UNITED CONCORDIA (01) | |
045187 | ANTHEM BCBS (01) | |
086224 | ANTHEM BCBS (01) | |
T21820 | (02) |