Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | C53606 | CA |
N | 207Q00000X | Family Doctor | 8735 | MT |
N | 207Q00000X | Family Doctor | C53606 | CA |
NPI | 1003902164 |
---|---|
Provider Name | Steven E. Kobrine |
First Address | Modesto, CA 95355-4201 |
Second Address | Turlock, CA 95380-3406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 06/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000823 | BCBS PIN (01) | MT |
0019091 | MDCD PIN (01) | MT |
114673400 | MDCD PIN (01) | WY |
G73694 | (02) | MT |