Provider Demographics
NPI:1467447565
Name:STEVENS, JAMES H JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1026 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6645
Practice Address - Country:US
Practice Address - Phone:850-863-5294
Practice Address - Fax:850-864-1648
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00681632085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377888600Medicaid
FL1179761OtherWELLCARE
AL009913035OtherAL. MCAID PSO PROVIDER #
AL118454 (CRO)Medicaid
FL16-01523OtherUTD. HLTHCR. PROVIDER #
AL009913045OtherAL. MCAID FWB PROVIDER #
FL212959OtherAVMED
AL009948615OtherAL. MCAID SRB PROVIDER #
AL118469 (DSF)Medicaid
FL8870766-006OtherCIGNA PROVIDER NUMBER
AL009913055OtherAL. MCAID CRO PROV. #
AL118458 (FWB)Medicaid
FL5120028OtherAETNA PROVIDER NUMBER
AL118471 (SRB)Medicaid
FL1179761OtherWELLCARE
FL16-01523OtherUTD. HLTHCR. PROVIDER #