Provider Demographics
NPI:1588664650
Name:STEPHENSON, ROBERT W (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 S CLEVELAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8959
Mailing Address - Country:US
Mailing Address - Phone:614-895-3344
Mailing Address - Fax:614-895-3795
Practice Address - Street 1:568 S CLEVELAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8959
Practice Address - Country:US
Practice Address - Phone:614-895-3344
Practice Address - Fax:614-895-3795
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005773208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0147460Medicaid
OHH029850Medicare PIN