Individual
PETER DOUGLAS STEPHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
188 E SOUTHWAY BLVD, KOKOMO, IN 46902-3650
(765) 453-9000
Mailing address
188 E SOUTHWAY BLVD, KOKOMO, IN 46902-3650
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01035748A
IN
207Q00000X
Family Medicine Physician
053956
GA
207Q00000X
Family Medicine Physician
55024
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01551745
—
IN
05
—
624637757A
—
GA
Enumeration date
06/24/2005
Last updated
08/03/2022
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