Healthcare Provider Details

I. General information

NPI: 1992764773
Provider Name (Legal Business Name): STEPHEN R. BELTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 SAMARITAN DR
SAN JOSE CA
95124-4005
US

IV. Provider business mailing address

2504 SAMARITAN DR
SAN JOSE CA
95124-4005
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-9171
  • Fax: 408-356-5848
Mailing address:
  • Phone: 408-356-9171
  • Fax: 408-356-5848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG039570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: