Provider Demographics
NPI:1548457203
Name:STEPHEN E. HATFIELD, DO LLC
Entity type:Organization
Organization Name:STEPHEN E. HATFIELD, DO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-461-0047
Mailing Address - Street 1:4850 E. BASELINE ROAD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-0000
Mailing Address - Country:US
Mailing Address - Phone:480-461-0047
Mailing Address - Fax:480-461-1103
Practice Address - Street 1:4850 E. BASELINE ROAD
Practice Address - Street 2:SUITE 118
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-0000
Practice Address - Country:US
Practice Address - Phone:480-461-0047
Practice Address - Fax:480-461-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ312231Medicaid
AZF69948Medicare PIN
AZF69948Medicare UPIN