Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN7011 | FL |
NPI | 1003905530 |
---|---|
Provider Name | Jeffrey Alan Stevens |
First Address | Pembroke Pines, FL 33024 |
Second Address | Pembroke Pines, FL 33024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T55242 | (02) |