MEDICARE: DR. STEVEN CHARLES POSSON D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20A6674	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020A66740	OTHER	CA	BLUE SHIELD PROV. #

General Provider Information

NPI Number	:	1376531897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN CHARLES POSSON D.O.

Provider Business Mailing Address
First Line	:	57 COUNTRY CLUB GATE
Second Line	:
City	:	PACIFIC GROVE
State	:	CA
Zip	:	93950-5041
Country	:	US
Telephone Number	:	805-441-2720
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 COUNTRY CLUB GATE
Second Line	:
City	:	PACIFIC GROVE
State	:	CA
Zip	:	93950-5041
Country	:	US
Telephone Number	:	805-441-2720
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	08/13/2012

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