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General NPI Number Information
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NPI Number | 1720207947
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Entity Type | Organization
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Legal Business Name | ROCKWALL MEDICAL ASSOCIATION PA
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 502 W KEARNEY ST SUITE 700
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City | MESQUITE
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State | TX
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Zip | 75149-3401
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Country | US
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Telephone | 972-288-7337
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Fax | 972-289-9076
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Provider Business Mailing Address
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Address Line | 502 W KEARNEY ST SUITE 700
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City | MESQUITE
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State | TX
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Zip | 75149-3401
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Country | US
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Telephone | 972-288-7337
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Fax | 972-289-9076
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | LAURA S STILES
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Credential | D.O.
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Telephone | 972-288-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | H8853
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License Number State | TX
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