Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | DP00191 | OR |
NPI | 1356452247 |
---|---|
Provider Name | Stephen Fekete |
First Address | Wilsonville, OR 97070-6482 |
Second Address | Wilsonville, OR 97070-6482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 23/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001342 | (05) | OR |
308335500 | BLUE CROSS BLUE SHIELD (01) | OR |
T67602 | (02) |