Provider Demographics
NPI:1164530382
Name:MICHAEL A. STEPHENS MD PA
Entity Type:Organization
Organization Name:MICHAEL A. STEPHENS MD PA
Other - Org Name:STEPHENS FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-264-9293
Mailing Address - Street 1:440 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4828
Mailing Address - Country:US
Mailing Address - Phone:904-264-9293
Mailing Address - Fax:904-264-7553
Practice Address - Street 1:440 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-264-9293
Practice Address - Fax:904-264-7553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF90354Medicare UPIN
FLK9573Medicare ID - Type UnspecifiedGROUP NUMBER