Provider Demographics
NPI:1508814732
Name:STEPHENS, ROBERT WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:DEPT 10
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6069
Mailing Address - Country:US
Mailing Address - Phone:317-844-5656
Mailing Address - Fax:317-575-3795
Practice Address - Street 1:12065 OLD MERIDIAN STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-844-5656
Practice Address - Fax:317-575-3795
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01024341A207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE29037Medicare UPIN
IN079890BMedicare ID - Type Unspecified