Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN12212 | FL |
NPI | 1073737912 |
---|---|
Provider Name | Dr. Barry Howard Stevens |
First Address | Jacksonville, FL 32204-4317 |
Second Address | Jacksonville, FL 32204-4317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |