Provider Demographics
NPI:1639307192
Name:STITH, BRIAN E (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:STITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BANK ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-2204
Mailing Address - Country:US
Mailing Address - Phone:515-832-6700
Mailing Address - Fax:515-832-3534
Practice Address - Street 1:1018 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5740
Practice Address - Country:US
Practice Address - Phone:515-663-8621
Practice Address - Fax:515-663-8620
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7182207Q00000X
IA04620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine