Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 21250 | SC |
N | 208600000X | Surgeon | 21250 | SC |
Y | 2086S0102X | Surgical Critical Care | 21250 | SC |
N | 2086S0127X | Trauma Surgeon | 21250 | SC |
NPI | 1366409161 |
---|---|
Provider Name | Dr. Stephen Austin Fann |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 15/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
212503 | (05) | SC |
H46910 | (02) |