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General NPI Number Information
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NPI Number | 1871622415
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Entity Type | Organization
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Legal Business Name | ROBERT L STOCKBURGER
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 408 E TYLER ST
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City | MEXIA
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State | TX
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Zip | 76667-3620
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Country | US
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Telephone | 254-472-0328
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 290538
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City | KERRVILLE
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State | TX
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Zip | 78029-0538
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | ROBERT STOCKBURGER
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Credential |
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Telephone | 254-472-0328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G4437
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License Number State | TX
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