Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | M6410 | TX |
NPI | 1164493060 |
---|---|
Provider Name | Raymond Matthew Stefko |
First Address | San Antonio, TX 78229-3735 |
Second Address | San Antonio, TX 78229-3735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 22/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
196305001 | (05) | TX |
F76862 | (02) | TX |