Basic Information
| Provider Information | |||||||||
| NPI: | 1841528577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPHAN J SERFONTEIN MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 534 | ||||||||
| Address2: | |||||||||
| City: | POINT PLEASANT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255500534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046756835 | ||||||||
| FaxNumber: | 3046756849 | ||||||||
| Practice Location | |||||||||
| Address1: | 2418 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | POINT PLEASANT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255501528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046756835 | ||||||||
| FaxNumber: | 3046756849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2009 | ||||||||
| LastUpdateDate: | 03/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | SERFONTEIN | ||||||||
| AuthorizedOfficialFirstName: | STEPHANUS | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 3046756835 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21778 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.