Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | MD00027265 | WA |
Y | 207VX0000X | Obstetrician | A29818 | CA |
NPI | 1659739472 |
---|---|
Provider Name | John David Stephens X |
First Address | Bellingham, WA 98225-7367 |
Second Address | Palo Alto, CA 94306-1636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2016 |
Last Update Date | 08/02/2016 |