Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 31147 | NE |
NPI | 1013449636 |
---|---|
Provider Name | Kyle Stigall |
First Address | Fort Sam Houston, TX 78234-4504 |
Second Address | Fort Sam Houston, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2017 |
Last Update Date | 10/10/2018 |