Provider Demographics
NPI:1750763041
Name:STETSON POWELL ORTHOPEDICS AND SPORTS MEDICINE
Entity type:Organization
Organization Name:STETSON POWELL ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:STETSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-848-3030
Mailing Address - Street 1:191 S BUENA VISTA ST
Mailing Address - Street 2:SUITE 470
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4554
Mailing Address - Country:US
Mailing Address - Phone:818-848-3030
Mailing Address - Fax:818-848-2228
Practice Address - Street 1:191 S BUENA VISTA ST
Practice Address - Street 2:SUITE 470
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4554
Practice Address - Country:US
Practice Address - Phone:818-848-3030
Practice Address - Fax:818-848-2228
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM B. STETSON MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty