Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | P114 | ID |
Y | 222Z00000X | Podiatrist | P114 | ID |
NPI | 1063426948 |
---|---|
Provider Name | Dr. William Scott Stano |
First Address | Boise, ID 83702-6044 |
Second Address | Boise, ID 83702-6044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 03/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000448700 | (05) | ID |
480004412 | RAILROAD MEDICARE (01) | ID |
T44263 | (02) | ID |