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Individual
BREK DAVID STOKER
Active
Individual
BREK DAVID STOKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AUD, CCC-A
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
H-412
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010143649
BLUE SHIELD OF ID
ID
05
—
805959200
—
ID
01
—
AU571
BLUE CROSS OF ID
ID
Enumeration date
05/25/2006
Last updated
03/31/2008
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