Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 6668 | NH |
NPI | 1164425641 |
---|---|
Provider Name | Dr. Stephen D. Elgert |
First Address | Bedford, NH 03110-6042 |
Second Address | Bedford, NH 03110-6042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 19/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80300001 | (05) | NH |
B85873 | (02) | NH |