Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PD211R | LA |
N | 2081S0010X | Sports Medicine | PD211R | LA |
N | 213ES0000X | Sports Medicine | PD211R | LA |
N | 213ES0103X | Foot & Ankle Surgery | PD211R | LA |
NPI | 1295041002 |
---|---|
Provider Name | Dr. Stephanie Michelle Jupiter |
First Address | Houston, TX 77082-1517 |
Second Address | Houston, TX 77082-1517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2010 |
Last Update Date | 23/11/2010 |