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General NPI Number Information
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NPI Number | 1053334813
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Entity Type | Individual
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Provider Name | DWIGHT GREGORY STEPHENS DPM
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 323 N PRAIRIE AVE SUITE 320
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City | INGLEWOOD
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State | CA
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Zip | 90301-4502
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Country | US
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Telephone | 310-671-5800
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Fax | 310-671-5810
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Provider Business Mailing Address
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Address Line | 323 N PRAIRIE AVE STE 320
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City | INGLEWOOD
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State | CA
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Zip | 90301-4505
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Country | US
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Telephone | 310-671-5800
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Fax | 310-671-5810
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E2206
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License Number State | CA
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