| Doctor Name: | DR. STEPHEN J IACOBONI |
| NPI Number: | 1497706162 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MD00024072 |
| Business Practice Address: | 216 W 10th Ave Suite 204 Kennewick, WA - 993366300 |
| Business Phone Number: | 5095852449 |
| Business Fax Number: | 5095252433 |
| Mailing Address: | Po Box 21015, 521 Hammill Ln. RENO |
| State: | NV |
| Postal Code: | 89515 |
| Phone Number: | 7758270707 |
| Fax Number: | 7758271006 |
| NPI Enumeration Date: | 05/15/2006 |
| NPI Last Update Date: | 09/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | MD00024072 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |