Provider Demographics
NPI:1548377740
Name:STOCKARD, STEVEN D (DPM)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:STOCKARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17401 NICHOLS LN
Mailing Address - Street 2:SUITE E
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5777
Mailing Address - Country:US
Mailing Address - Phone:562-761-4388
Mailing Address - Fax:714-908-1970
Practice Address - Street 1:17401 NICHOLS LN
Practice Address - Street 2:SUITE E
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5777
Practice Address - Country:US
Practice Address - Phone:562-761-4388
Practice Address - Fax:714-908-1970
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4255213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWE4255BMedicare ID - Type UnspecifiedMEDICARE ID#
CAU88908Medicare UPIN