Provider Demographics
NPI:1093983157
Name:STEPHENSON, DAVID WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WAYNE
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9202 NW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-7413
Mailing Address - Country:US
Mailing Address - Phone:352-812-0579
Mailing Address - Fax:352-571-4349
Practice Address - Street 1:9202 NW 26TH ST
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-7413
Practice Address - Country:US
Practice Address - Phone:352-812-0579
Practice Address - Fax:352-571-4349
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106525207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14F4LOtherBCBS
FLFD876ZMedicare PIN