Provider Demographics
NPI:1154600633
Name:FUNKHOUSER, STEPHEN KEITH (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KEITH
Last Name:FUNKHOUSER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1202 MEDICAL CENTER DRIVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-3300
Mailing Address - Fax:910-251-2067
Practice Address - Street 1:1202 MEDICAL CENTER DRIVE
Practice Address - Street 2:ATTN: CREDENTIALING
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7307
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-251-2067
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2016-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2016-01096208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist