Basic Information
| Provider Information | |||||||||
| NPI: | 1053396812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOKES | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1193 NORTON AVE | ||||||||
| Address2: | SUITE A. | ||||||||
| City: | NORTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442039516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308250847 | ||||||||
| FaxNumber: | 3308259569 | ||||||||
| Practice Location | |||||||||
| Address1: | 1193 NORTON AVE | ||||||||
| Address2: | SUITE A. | ||||||||
| City: | NORTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442039516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308250847 | ||||||||
| FaxNumber: | 3308259569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2005 | ||||||||
| LastUpdateDate: | 11/18/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | 35055544S | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080015179 | 01 | OH | RAILROAD MEDICARE NUMBER | OTHER | 0933708 | 05 | OH | MEDICAID |