Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME142141 | FL |
N | 111NI0900X | Internist | ME142141 | FL |
N | 207RH0000X | Hematologist | ME142141 | FL |
Y | 207RX0202X | Medical Oncology | ME142141 | FL |
NPI | 1356545818 |
---|---|
Provider Name | Dr. Stephen John Vara |
First Address | Fort Myers, FL 33916-2216 |
Second Address | North Port, FL 34286-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 24/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103960400 | (05) | FL |