Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036092867 | IL |
N | 207XS0106X | Orthopaedic Hand Surgeon | 036092867 | IL |
Y | 207XS0106X | Orthopaedic Hand Surgeon | MD00023255 | WA |
NPI | 1235191297 |
---|---|
Provider Name | John Martin Stogin JR. |
First Address | Chicago, IL 60611-6662 |
Second Address | Chicago, IL 60611-6662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 05/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036092867 | (05) | IL |
E66829 | (02) |