Provider Demographics
NPI:1861706392
Name:VERONNEAU, STEPHEN J H (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J H
Last Name:VERONNEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 S 216TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6547
Mailing Address - Country:US
Mailing Address - Phone:405-623-2510
Mailing Address - Fax:206-878-6713
Practice Address - Street 1:27427 12TH PL S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-9418
Practice Address - Country:US
Practice Address - Phone:405-623-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350552752083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine