| Patient | Stephanie Suzanne Affleck | Preferred Language | en |
| Date of birth | November 2, 1970 | Sex | Female |
| Race | White
|
Ethnicity | Not Hispanic or Latino |
| Contact info | Home:
4651 E Sunnyside Rd Idaho Falls, ID 83406, US Tel (Mobile): +1(208)-709-6674 Tel (Primary Home): +1(208)-523-4505 Tel (Work Place): +1(208)-523-6868 Mail: sswa.affleck@gmail.com Mail: manager@affleckmd.com |
Patient IDs | 2465269 2.16.840.1.113883.3.3710.999.44.88800115636.7770000101
MM0000000737 2.16.840.1.113883.3.3710.3 MODMED 2.16.840.1.113883.3.3710.200.501 115636PAT000000746 2.16.840.1.113883.3.3710.200.500 |
| Document Id | test-id-1912433223 2.16.840.1.113883.3.3710.0 |
| Document Created: | April 7, 2024, 15:41:24 +0000 |
| Author | Diana Tagaban, Jaime S. Schwartz, MD |
| Contact info | Work Place:
240 S La Cienega Blvd Ste 200 Beverly Hills, CA 902113324, US Tel (Work Place): 3108825454 |
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| Encounter Date | From , to , | ||
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| Legal authenticator | Diana Tagaban signed at April 7, 2024, 15:41:24 +0000 |
| Contact info | Work Place:
240 S La Cienega Blvd Ste 200 Beverly Hills, CA 902113324, US Tel (Work Place): 3108825454 |
| Document maintained by | Jaime S. Schwartz, MD |
| Contact info | Work Place:
240 S La Cienega Blvd Ste 200 Beverly Hills, CA 902113324, US Tel (Work Place): 3108825454 |