Provider Demographics
NPI:1154826683
Name:STEPHENS, NATHAN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JAMES
Last Name:STEPHENS
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 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1251 HUNTZINGER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-9404
Practice Address - Country:US
Practice Address - Phone:765-298-4567
Practice Address - Fax:765-298-4568
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.137484207Q00000X
IN01085040A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INQ00382721OtherRAILROAD MEDICARE