Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 5612 | KY |
NPI | 1003974239 |
---|---|
Provider Name | Mr. Bradley Norfleet Stearsman |
First Address | Owensboro, KY 42303 |
Second Address | Owensboro, KY 42303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |