Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 28105 | IA |
NPI | 1023008810 |
---|---|
Provider Name | Dr. Stuart James Kolner |
First Address | Ames, IA 50014-7595 |
Second Address | Ames, IA 50010-3014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 03/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0095745 | (05) | IA |
F53888 | (02) | IA |