Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RN0300X | Nephrologist | 27566 | KY |
Y | 207RN0300X | Nephrologist | 35-05-3679-S | OH |
NPI | 1063456036 |
---|---|
Provider Name | Dr. Gregory W Stephens |
First Address | Cincinnati, OH 45219-2906 |
Second Address | Cincinnati, OH 45219-2906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 07/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0630124 | (05) | OH |
100324150 | (05) | IN |
390007100 | MEDICARE RAILROAD (01) | OH |
64787211 | (05) | KY |
C03095 | (02) |