Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 35060576 | OH |
NPI | 1114901188 |
---|---|
Provider Name | Dr. Michael Wayne Stevens |
First Address | Dayton, OH 45409-1332 |
Second Address | Dayton, OH 45409-1332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0381831 | (05) | OH |
E78802 | (02) |