Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | IL | |
Y | 208600000X | Surgeon | IL |
NPI | 1003888793 |
---|---|
Provider Name | Dr. Stephen Antonioli Jennings |
First Address | Kirtland Afb, NM 87117-5522 |
Second Address | Kirtland Afb, NM 87117-5522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 08/07/2007 |