Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 04014111498 | VA |
Y | 1223P0700X | Prosthodontist | 28864 | TX |
NPI | 1265460497 |
---|---|
Provider Name | Dr. Stewart Whitney Pharr |
First Address | Austin, TX 78749 |
Second Address | Austin, TX 78749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 31/07/2015 |