Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | ME112692 | FL |
N | 207R00000X | Internist | 149124 | NC |
N | 111NI0900X | Internist | 149124 | NC |
NPI | 1154596898 |
---|---|
Provider Name | Stephan M. Esser |
First Address | Jacksonville, FL 32216-8070 |
Second Address | Ponte Vedra Beach, FL 32082-6600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2008 |
Last Update Date | 25/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007267700 | (05) | FL |
12057 | (05) | AZ |