Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 15950 | CO |
NPI | 1013980143 |
---|---|
Provider Name | Stephen R Meacham |
First Address | Grand Junction, CO 81501-8845 |
Second Address | Grand Junction, CO 81501-8845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01159508 | (05) | CO |
D28166 | (02) | CO |