Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 35438-020 | WI |
NPI | 1134105976 |
---|---|
Provider Name | Dr. Keith Stuessi |
First Address | Camp Pendleton, CA 92055-5191 |
Second Address | Camp Pendleton, CA 92055-5191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 08/07/2007 |