Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | D41813 | MD |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | D41813 | MD |
NPI | 1134193428 |
---|---|
Provider Name | Jesse Stephens Julian JR. |
First Address | Carrollton, VA 23314 |
Second Address | Carrollton, VA 23314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 25/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
765081700 | (05) | MD |
D27043 | (02) |