1124150164 NPI number — MRS. MARIA A STILES M.D.

Table of content: MRS. MARIA A STILES M.D. (NPI 1124150164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124150164 NPI number — MRS. MARIA A STILES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STILES
Provider First Name:
MARIA
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MASSANET
Provider Other First Name:
MARIA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124150164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 MACON DR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36265-2659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-933-8101
Provider Business Mailing Address Fax Number:
256-413-7813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 RESCIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAINBOW CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35906-5933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-933-8101
Provider Business Practice Location Address Fax Number:
256-413-7813
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  12549 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12549 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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