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General NPI Number Information
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NPI Number | 1043323629
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Entity Type | Individual
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Provider Name | STEPHEN JOHN CROUGHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 11/03/2022
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Provider Practice Location Address
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Address Line | 2937 BEYER BLVD
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City | SAN DIEGO
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State | CA
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Zip | 92154
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Country | US
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Telephone | 310-627-2378
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Fax | 801-749-4963
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Provider Business Mailing Address
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Address Line | P.O. BOX 927704
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City | SAN DIEGO
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State | CA
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Zip | 92192-7704
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Country | US
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Telephone | 310-627-2378
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Fax | 619-423-0340
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A41669
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License Number State | CA
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