Provider Demographics
NPI:1386642478
Name:STEPHENSON, ROBERT LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:320 SANTA FE DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5138
Mailing Address - Country:US
Mailing Address - Phone:760-943-6730
Mailing Address - Fax:760-943-6733
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:SUITE 303
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-943-6730
Practice Address - Fax:760-943-6733
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG65902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG65902OtherSTATE LICENSE
CAG65902OtherSTATE LICENSE
CAD24449Medicare UPIN
CA84-0910982OtherTAX ID NUMBER