Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 125474 | FL |
NPI | 1134170806 |
---|---|
Provider Name | Rick Brian Stevens |
First Address | Omaha, NE 68198-8095 |
Second Address | Pensacola, FL 32504-8755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 17/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015723600 | (05) | FL |
E75497 | (02) | NE |