Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OPP00160 | AR |
N | 222Z00000X | Podiatrist | OPP00160 | AR |
Y | 224P00000X | Prosthetist | OPP00160 | AR |
NPI | 1003053752 |
---|---|
Provider Name | Steven E Street |
First Address | Little Rock, AR 72205-2130 |
Second Address | Little Rock, AR 72205-2130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2009 |
Last Update Date | 16/01/2009 |