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Individual
DR. STEPHEN AUSTIN FANN
Active
Individual
DR. STEPHEN AUSTIN FANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
21250
SC
2086S0102X
Surgical Critical Care Physician
Primary
21250
SC
2086S0127X
Trauma Surgery Physician
21250
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212503
—
SC
Enumeration date
04/27/2006
Last updated
12/15/2011
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