Provider Demographics
NPI:1710258157
Name:STEGMAN, DAVID W
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:STEGMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:W
Other - Last Name:STEGMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5886 SANTA LUCIA CT
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1160
Mailing Address - Country:US
Mailing Address - Phone:805-639-9249
Mailing Address - Fax:805-639-9249
Practice Address - Street 1:5886 SANTA LUCIA CT
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1160
Practice Address - Country:US
Practice Address - Phone:805-639-9249
Practice Address - Fax:805-639-9249
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE 15514207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine