Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 01024995A | IN |
Y | 207W00000X | Ophthalmologist | 01024995A | IN |
NPI | 1215082813 |
---|---|
Provider Name | Dr. Steven E Stoller |
First Address | Richmond, IN 47374-1844 |
Second Address | Richmond, IN 47374-1844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 18/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100256210 | (05) | IN |
E03894 | (02) | IN |