Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 2624 | AZ |
Y | 213EG0000X | General Practice | 2624 | AZ |
NPI | 1003035437 |
---|---|
Provider Name | Dr. Stephen Vann |
First Address | Mesa, AZ 85208 |
Second Address | Mesa, AZ 85208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 25/11/2009 |