Individual
DR. DUSTIN ALLEN COPELAND STALOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
301 UNIVERSITY BLVD, GALVESTON, TX 77555-2102
(409) 772-1011
Mailing address
1364 CLIFTON RD NE, ATLANTA, GA 30307-2102
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
77317
GA
207RC0000X
Cardiovascular Disease Physician
V3437
TX
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
V3437
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2015
Last updated
11/13/2024
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