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General NPI Number Information
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NPI Number | 1215209903
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Entity Type | Organization
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Legal Business Name | STEPHEN A. HABENER, M.D., INC., P.S.
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 2635 WHEATON WAY
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City | BREMERTON
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State | WA
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Zip | 98310-3318
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Country | US
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Telephone | 360-373-2571
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Fax | 360-479-4970
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Provider Business Mailing Address
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Address Line | 2635 WHEATON WAY
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City | BREMERTON
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State | WA
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Zip | 98310-3318
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Country | US
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Telephone | 360-373-2571
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Fax | 360-479-4970
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS TIA L SMART
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Credential |
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Telephone | 360-373-2571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD00011593
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License Number State | WA
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