Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME87575 | FL |
NPI | 1003890435 |
---|---|
Provider Name | Stephanie Dechurch |
First Address | Miami, FL 33173-2539 |
Second Address | Miami, FL 33173-2539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 08/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
266990100 | (05) | FL |