Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 01025457 | IN |
N | 208D00000X | General Practice Physician | 35038172 | OH |
NPI | 1033256805 |
---|---|
Provider Name | W. Kenneth Stephens |
First Address | Cincinnati, OH 45221-0010 |
Second Address | Cincinnati, OH 45221-0010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |