Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 013727 | LA |
NPI | 1194724559 |
---|---|
Provider Name | Charles M Stedman |
First Address | Baton Rouge, LA 70895-9009 |
Second Address | Baton Rouge, LA 70815-4114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B62959 | (02) |