Basic Information
| Provider Information | |||||||||
| NPI: | 1639307192 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STITH | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 BANK ST | ||||||||
| Address2: | |||||||||
| City: | WEBSTER CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505952204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5158326700 | ||||||||
| FaxNumber: | 5158323534 | ||||||||
| Practice Location | |||||||||
| Address1: | 1018 DUFF AVE | ||||||||
| Address2: | |||||||||
| City: | AMES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500105740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5156638621 | ||||||||
| FaxNumber: | 5156638620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2009 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 7182 | KS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 04620 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.