Individual
DR. ROBERT L KISTNER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2755 SILVER CREEK RD STE 111, BULLHEAD CITY, AZ 86442-8343
(928) 704-7163
Mailing address
PO BOX 50970, PHOENIX, AZ 85076-0970
(480) 706-6151
(480) 706-8908
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
AZ20804
AZ
208600000X
Surgery Physician
Primary
35056109
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0491638
—
OH
05
—
130170
—
AZ
Enumeration date
08/19/2005
Last updated
03/13/2024
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