Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | 01067241A | IN |
N | 2080N0001X | Neonatal-Perinatal Doctor | 40152 | KY |
NPI | 1073593158 |
---|---|
Provider Name | Dr. Stephan Edwin Pepple |
First Address | Fort Wayne, IN 46804-4140 |
Second Address | Fort Wayne, IN 46804-4140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 05/04/2013 |