Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301090217 | MI |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A127025 | CA |
N | 207YS0123X | Facial Plastic Surgeon | 4301090217 | MI |
N | 207YS0123X | Facial Plastic Surgeon | A127025 | CA |
NPI | 1417150913 |
---|---|
Provider Name | Dr. Jon-Paul Pepper |
First Address | Stanford, CA 94305-2200 |
Second Address | Stanford, CA 94305-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 10/08/2017 |