Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ME153971 | FL |
NPI | 1033773148 |
---|---|
Provider Name | Gauthier Luc Stepman |
First Address | Trinity, FL 34655-1808 |
Second Address | Trinity, FL 34655-1808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2019 |
Last Update Date | 18/01/2022 |