Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 1906 | MA |
NPI | 1104840974 |
---|---|
Provider Name | Dr. Stephen Patrick Tubridy |
First Address | Chestnut Hill, MA 02467-2116 |
Second Address | Chestnut Hill, MA 02467-2116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0362948 | (05) | MA |
T91484 | (02) | MA |