Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 015860 | ME |
NPI | 1003985714 |
---|---|
Provider Name | William B Stephenson |
First Address | Rockport, ME 04856-4460 |
Second Address | Rockport, ME 04856-4460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 06/01/2012 |