Healthcare Provider Details

I. General information

NPI: 1003053323
Provider Name (Legal Business Name): JAMIE LYNDON STECKLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 RED OAK AVE
LONDON ONTARIO
N6H 5R6
CA

IV. Provider business mailing address

872 RED OAK AVE
LONDON ONTARIO
N6H 5R6
CA

V. Phone/Fax

Practice location:
  • Phone: 519-474-3613
  • Fax:
Mailing address:
  • Phone: 519-474-3613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number80974
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: