Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 2991 | AZ |
NPI | 1184666216 |
---|---|
Provider Name | Stephen E Hatfield |
First Address | Mesa, AZ 85206-4625 |
Second Address | Mesa, AZ 85206-4625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F69948 | (02) | AZ |