Individual
GRANT WILKES STEPHENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 1/2 GOODRICH ST, RIPLEY, NY 14775-9546
(716) 736-6300
(716) 736-6302
Mailing address
PO BOX 693, RIPLEY, NY 14775-0693
(716) 736-6300
(716) 736-6302
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
170427
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01041730
—
NY
Enumeration date
03/07/2006
Last updated
10/25/2007
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