Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | ME0072747 | FL |
NPI | 1235142969 |
---|---|
Provider Name | Stephen L. Helgemo JR. |
First Address | Port Charlotte, FL 33948-1008 |
Second Address | Port Charlotte, FL 33948-1008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 02/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21069 | BLUE CROSS BLUE SHEILD (01) | |
279078500 | (05) | FL |
280461 | WELLCARE HMO (01) | |
5294520 | ETNA (01) | |
G23121 | (02) | |
P00267480 | RAIL ROAD MEDICARE (01) |