Provider Demographics
NPI:1902919004
Name:STEADY, STEPHEN LEO (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEO
Last Name:STEADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1383 N MCDOWELL BLVD
Mailing Address - Street 2:STE 110A
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1190
Mailing Address - Country:US
Mailing Address - Phone:707-766-9852
Mailing Address - Fax:707-766-1749
Practice Address - Street 1:1383 N MCDOWELL BLVD
Practice Address - Street 2:STE 110A
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1190
Practice Address - Country:US
Practice Address - Phone:707-766-9852
Practice Address - Fax:707-766-1749
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA44200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A442000Medicaid
CA00A442000Medicaid
CA00A442000Medicare PIN