Provider Demographics
NPI:1407991250
Name:STEPHENS, AMBER R (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:R
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-4650
Mailing Address - Country:US
Mailing Address - Phone:727-733-5100
Mailing Address - Fax:727-498-2401
Practice Address - Street 1:1551 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-4650
Practice Address - Country:US
Practice Address - Phone:727-498-2401
Practice Address - Fax:727-498-2401
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00634854OtherRAILROAD MEDICARE PROVIDER NUMBER
FL000518400Medicaid
FLP00684614OtherRAILROAD MEDICARE PROVIDER NUMBER
FLAM312ZMedicare PIN
FLAM312YMedicare PIN