Provider Demographics
NPI:1770510117
Name:VIESS, STEPHEN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:VIESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 PORTER DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1587
Mailing Address - Country:US
Mailing Address - Phone:925-314-8460
Mailing Address - Fax:925-838-2481
Practice Address - Street 1:4000 DUBLIN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3113
Practice Address - Country:US
Practice Address - Phone:925-556-7320
Practice Address - Fax:925-497-0231
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA71570207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A715700OtherBLUE SHIELD
CA00A715702Medicare PIN
CA00A715700OtherBLUE SHIELD