Healthcare Provider Details

I. General information

NPI: 1922088392
Provider Name (Legal Business Name): DARRYL DAVID STINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 NW WILSON ST
APO AA
73503-9042
US

IV. Provider business mailing address

3009 NW WILSON ST. RADIOLOGY DEPT
FORT SILL OK
73503-9042
US

V. Phone/Fax

Practice location:
  • Phone: 580-458-2781
  • Fax: 580-458-2505
Mailing address:
  • Phone: 580-458-2781
  • Fax: 580-458-2505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0116017066
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: