Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 01030272 | IN |
NPI | 1053404947 |
---|---|
Provider Name | John C Stevens |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 18/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000354898 | ANTHEM-DEAC-350593390 (01) | |
100227810 | (05) | IN |
1053404947 | (05) | MI |
1801852 | (05) | LA |
350593390 | UPA-237328642 (01) | |
350593390-042 | TRICARE-DEAC-350593390 (01) | |
64880370 | (05) | KY |
C25642 | (02) |