Healthcare Provider Details

I. General information

NPI: 1902015498
Provider Name (Legal Business Name): STEPHEN R STEELE DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78120 WILDCAT DR
PALM DESERT CA
92211-1140
US

IV. Provider business mailing address

78120 WILDCAT DR
PALM DESERT CA
92211-1140
US

V. Phone/Fax

Practice location:
  • Phone: 760-360-1433
  • Fax: 760-360-5092
Mailing address:
  • Phone: 760-360-1433
  • Fax: 760-360-5092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20A555
License Number StateCA

VIII. Authorized Official

Name: DR. STEPHEN R STEELE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 760-360-1433