Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN5029 | FL |
NPI | 1053313296 |
---|---|
Provider Name | Dr. Stephen C Trawick |
First Address | Pensacola, FL 32504-8622 |
Second Address | Pensacola, FL 32504-8622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 08/07/2007 |