Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 2600 | TX |
NPI | 1265692867 |
---|---|
Provider Name | Stephen R Tomko |
First Address | Coppell, TX 75019-4583 |
Second Address | Coppell, TX 75019-4583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 10/02/2012 |