Doctor Name: | DR. ROBERT L KISTNER |
NPI Number: | 1063404572 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | AZ20804 |
Business Practice Address: | 875 N Greenfield Rd Suite 108 Gilbert, AZ - 852345044 |
Business Phone Number: | 4807066151 |
Business Fax Number: | 4807068908 |
Mailing Address: | Po Box 50970, PHOENIX |
State: | AZ |
Postal Code: | 850760970 |
Phone Number: | 4807066151 |
Fax Number: | 4807068908 |
NPI Enumeration Date: | 08/19/2005 |
NPI Last Update Date: | 10/22/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | AZ20804 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |