Provider Demographics
NPI:1477863074
Name:DR. PETER STEPHENS INC
Entity Type:Organization
Organization Name:DR. PETER STEPHENS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:863-763-0880
Mailing Address - Street 1:375 SW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-5919
Mailing Address - Country:US
Mailing Address - Phone:863-763-0880
Mailing Address - Fax:
Practice Address - Street 1:375 SW 32ND ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-5919
Practice Address - Country:US
Practice Address - Phone:863-763-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 3189261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88368OtherMEDICARE BCBS
FL88368OtherMEDICARE BCBS