Healthcare Provider Details

I. General information

NPI: 1669699799
Provider Name (Legal Business Name): STEVEN J. PACKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23625 HOLMAN HWY
MONTEREY CA
93940-5902
US

IV. Provider business mailing address

23625 HOLMAN HWY
MONTEREY CA
93940-5902
US

V. Phone/Fax

Practice location:
  • Phone: 831-625-2450
  • Fax: 831-625-4948
Mailing address:
  • Phone: 831-625-2450
  • Fax: 831-625-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG50734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: