Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 046084 | GA |
NPI | 1023128675 |
---|---|
Provider Name | Stephen Michael Durso |
First Address | Macon, GA 31201 |
Second Address | Macon, GA 31201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00949528A | (05) | GA |
H00681 | (02) |