Basic Information
Provider Information
NPI: 1013277045
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HEMPERLY
FirstName: STEPHEN
MiddleName: ERIK
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2285 CORPORATE CIR
Address2: STE 200
City: HENDERSON
State: NV
PostalCode: 890747759
CountryCode: US
TelephoneNumber: 7023602763
FaxNumber: 9497832880
Practice Location
Address1: 4060 FOURTH AVE STE 415
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 92103
CountryCode: US
TelephoneNumber: 6192989809
FaxNumber: 6192989823
Other Information
ProviderEnumerationDate: 05/24/2012
LastUpdateDate: 08/20/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000X14658CAY Allopathic & Osteopathic PhysiciansDermatology 

No ID Information.


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