Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MD08873 | RI |
NPI | 1093776296 |
---|---|
Provider Name | Russell Drew Stokes |
First Address | Westerly, RI 02891-2717 |
Second Address | Westerly, RI 02891-2717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E51701 | (02) | RI |
RS34194 | (05) | RI |