Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | SC006617 | PA |
NPI | 1366842270 |
---|---|
Provider Name | Dr. Kevin Stonestreet |
First Address | Ford City, PA 16226-1268 |
Second Address | Ford City, PA 16226-1268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2014 |
Last Update Date | 27/08/2014 |