Provider Demographics
NPI:1225010473
Name:STEVENS, FRANK W JR (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:W
Last Name:STEVENS
Suffix:JR
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 1:3205 RANDALL PARKWAY
Mailing Address - Street 2:SUITE 122
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-332-4130
Mailing Address - Fax:910-332-4131
Practice Address - Street 1:3205 RANDALL PARKWAY
Practice Address - Street 2:SUITE 122
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-332-4130
Practice Address - Fax:910-332-4131
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96014902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8979780Medicaid
NC8979780Medicaid
D70199Medicare UPIN
NCD70199Medicare UPIN