Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 7725 | HI |
Y | 207QA0505X | Family Doctor - Adult Medicine | 58583 | AZ |
NPI | 1184610800 |
---|---|
Provider Name | Dr. Terry Kulia Stevenson |
First Address | Yuma, AZ 85367-7849 |
Second Address | Yuma, AZ 85367-7849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 05/07/2021 |