Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 085.006142 | IL |
NPI | 1053833343 |
---|---|
Provider Name | Stuart Kent Lankford |
First Address | Carbondale, IL 62901-5336 |
Second Address | Carbondale, IL 62901-5336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2017 |
Last Update Date | 10/01/2019 |