Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25MA06250500 | NJ |
N | 208000000X | Pediatrician | MD038928E | PA |
N | 2080P0202X | Pediatric Cardiologist | 25MA06250500 | NJ |
Y | 2080P0202X | Pediatric Cardiologist | MD038928E | PA |
NPI | 1235153743 |
---|---|
Provider Name | Paul Stephens JR. |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 27/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001092670 | (05) | PA |
6705006 | (05) | NJ |
C33005 | (02) |