Provider Demographics
NPI:1316074776
Name:SOUTHARD, STEPHEN E JR (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:SOUTHARD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1160 HICKORY WAY
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-7994
Mailing Address - Country:US
Mailing Address - Phone:617-840-8445
Mailing Address - Fax:617-789-9549
Practice Address - Street 1:1160 HICKORY WAY
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-7994
Practice Address - Country:US
Practice Address - Phone:617-840-8445
Practice Address - Fax:617-789-9549
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAL-228504207R00000X
COCDRH.0061297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine