Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E2619 | CA |
NPI | 1073598603 |
---|---|
Provider Name | Dr. Stephen Joseph Medawar |
First Address | Carmichael, CA 95608-6333 |
Second Address | Carmichael, CA 95608-6333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 21/06/2016 |