Individual
STEPHEN D HATHWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 445-7226
Mailing address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 445-7226
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19109
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19109
WI LICENSE
WI
Enumeration date
03/01/2010
Last updated
03/01/2010
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