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Individual
STANLEY A AGBULOS
Active
Individual
STANLEY A AGBULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, AA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005073
GA
363A00000X
Physician Assistant
PA16336
CA
367H00000X
Anesthesiologist Assistant
005073
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
259983019A
—
GA
01
—
P00410142
RRB
GA
05
—
PA16336
—
CA
Enumeration date
12/14/2005
Last updated
02/28/2011
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