Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 02137 | KY |
N | 207Q00000X | Family Doctor | 02137 | KY |
NPI | 1649318221 |
---|---|
Provider Name | Edward G. Stiles |
First Address | Pikeville, KY 41502-0432 |
Second Address | Pikeville, KY 41501-1518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2007 |
Last Update Date | 03/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000221139 | ANTHEM (01) | KY |
64050818 | (05) | KY |
C94612 | (02) | KY |