Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 0101056269 | VA |
Y | 208800000X | Urologist | 061968 | GA |
NPI | 1063580207 |
---|---|
Provider Name | Dr. Trent Douglas Sterenchock |
First Address | Beaumont, TX 77702 |
Second Address | Beaumont, TX 77702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 27/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
705543780A | (05) | GA |
705543780B | (05) | GA |