Individual
DR. STEPHEN MARK SCALLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 CURVE CREST BLVD W, STILLWATER, MN 55082-6040
(651) 439-1234
(651) 439-1547
Mailing address
8170 33RD AVE S # MS 21110Q, MINNEAPOLIS, MN 55425-4516
(651) 439-1234
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
24613
WI
208000000X
Pediatrics Physician
Primary
29155
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179773500
—
MN
05
—
30626700
—
WI
Enumeration date
11/23/2005
Last updated
07/08/2019
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