Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | E2886 | AR |
N | 207ND0101X | MOHS-Micrographic Surgeon | E2886 | AR |
NPI | 1093715047 |
---|---|
Provider Name | Mr. Adam Stefan Stibich |
First Address | Hot Springs, AR 71913-6404 |
Second Address | Hot Springs, AR 71913-6404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 08/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
143844001 | (05) | AR |
18885000000 | QUALCHOICE (01) | AR |
7237284 | AETNA (01) | |
E2886 | STATE LICENSE (01) | AR |
H34786 | (02) |