Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4301050235 | MI |
NPI | 1003942822 |
---|---|
Provider Name | Peter Stevenson |
First Address | Dearborn, MI 48124-2923 |
Second Address | Dearborn, MI 48124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |