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Individual

MR. BRIAN DEAN STODDARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
B.L.S.

Contact information

Practice address
14 MURPHY CIR, BROWNSBURG, IN 46112-2134
(317) 966-5044
Mailing address
14 MURPHY CIR, BROWNSBURG, IN 46112-2134
(317) 966-5044

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
201043780A
INDIANA HEALTH COVERAGE PROGRAMS
IN
Enumeration date
02/02/2012
Last updated
02/02/2012
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