Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | DO2192 | NV |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | SL0953 | NV |
NPI | 1053759282 |
---|---|
Provider Name | Stanley Scott Poole |
First Address | Chicago, IL 60673-4639 |
Second Address | Las Vegas, NV 89109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2013 |
Last Update Date | 29/10/2019 |