Healthcare Provider Details

I. General information

NPI: 1619949278
Provider Name (Legal Business Name): STEPHEN P MEESE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 METKER TRL SUITE A
STANFORD KY
40484-1049
US

IV. Provider business mailing address

107 METKER TRL SUITE A
STANFORD KY
40484-1049
US

V. Phone/Fax

Practice location:
  • Phone: 606-365-8338
  • Fax: 606-365-8142
Mailing address:
  • Phone: 606-365-8338
  • Fax: 606-365-8142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34.006666
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02536
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: