Provider Demographics
NPI:1306841937
Name:STEPHANS, RONALD EUGENE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EUGENE
Last Name:STEPHANS
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 1:2995 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:4211 VAN DYKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8005
Practice Address - Country:US
Practice Address - Phone:813-960-4026
Practice Address - Fax:813-960-4489
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264682000Medicaid
FLD61104Medicare UPIN
FL04558XMedicare PIN
FL264682000Medicaid