Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | R1K77 | MO |
N | 207YP0228X | Pediatric Otolaryngology | R1K77 | MO |
NPI | 1164449757 |
---|---|
Provider Name | John A Stith |
First Address | St Louis, MO 63110 |
Second Address | St Louis, MO 63110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |