Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | PSYCHOL 3521 | AZ |
NPI | 1093896318 |
---|---|
Provider Name | David Edwin Stetson |
First Address | Nogales, AZ 85621-2644 |
Second Address | Safford, AZ 85546-2103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
970382 | AZ AHCCCES (01) | AZ |