Basic Information
Provider Information
NPI: 1659573830
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEGMAN
FirstName: BRYAN
MiddleName: KEITH
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 236
Address2:  
City: BATESVILLE
State: IN
PostalCode: 470060236
CountryCode: US
TelephoneNumber: 8129335441
FaxNumber:  
Practice Location
Address1: 321 MITCHELL AVE
Address2:  
City: BATESVILLE
State: IN
PostalCode: 470068909
CountryCode: US
TelephoneNumber: 8129346624
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/01/2007
LastUpdateDate: 03/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/29/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X01063281AINY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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