Provider Demographics
NPI:1285042713
Name:STILL, STEVEN (IDC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:STILL
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS FIRBOLT PC 10
Mailing Address - Street 2:FPOAE 09569 1969
Mailing Address - City:MANAMA
Mailing Address - State:MANAMA
Mailing Address - Zip Code:09569 1969
Mailing Address - Country:BH
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USS FIREBOLT PC 10
Practice Address - Street 2:
Practice Address - City:MANAMA
Practice Address - State:MANAMA
Practice Address - Zip Code:FPO AE 09569 1969
Practice Address - Country:BH
Practice Address - Phone:318-439-9766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman