Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | SC003157L | PA |
NPI | 1265584817 |
---|---|
Provider Name | Dr. Thomas Kent Stickley |
First Address | West Chester, PA 19380-4805 |
Second Address | West Chester, PA 19380-4805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 19/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
067363 | (02) | |
067363 | BLUE CROSS BLUE SHIELD (01) | PA |
U02028 | (02) | PA |