Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME88079 | FL |
NPI | 1407811235 |
---|---|
Provider Name | Dr. Jeannine Marie Stein |
First Address | Melbourne, FL 32940-8565 |
Second Address | Melbourne, FL 32940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 14/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
280413100 | (05) | FL |
G95966 | (02) | FL |