Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G5475 | CA |
NPI | 1285741058 |
---|---|
Provider Name | Dr. Mark Bruce Stern |
First Address | Rancho Mirage, CA 92270-2587 |
Second Address | Loma Linda, CA 92357-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 08/07/2007 |