Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 133 | AR |
Y | 222Z00000X | Podiatrist | 133 | AR |
NPI | 1053311944 |
---|---|
Provider Name | Mr. Stephen Samuel Pirotta |
First Address | Bentonville, AR 72712-4196 |
Second Address | Bentonville, AR 72712-4196 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 04/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114047438 | NPI (01) | AR |
129007717 | (05) | AR |
480033075 | RR MCR (01) | |
U32668 | (02) |