Provider Demographics
NPI:1235401589
Name:STODDARD, BRIAN DEAN (BLS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DEAN
Last Name:STODDARD
Suffix:
Gender:M
Credentials:BLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MURPHY CIR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2134
Mailing Address - Country:US
Mailing Address - Phone:317-966-5044
Mailing Address - Fax:
Practice Address - Street 1:14 MURPHY CIR
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2134
Practice Address - Country:US
Practice Address - Phone:317-966-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201043780AOtherINDIANA HEALTH COVERAGE PROGRAMS