Provider Demographics
NPI:1598147118
Name:STEPANENKO, BRYAN ALEXANDER (MD, MPH, FAAFP)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:ALEXANDER
Last Name:STEPANENKO
Suffix:
Gender:M
Credentials:MD, MPH, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 N BAYLEN ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-3901
Mailing Address - Country:US
Mailing Address - Phone:850-444-8856
Mailing Address - Fax:785-240-7438
Practice Address - Street 1:423 N BAYLEN ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3901
Practice Address - Country:US
Practice Address - Phone:850-444-8856
Practice Address - Fax:850-285-0161
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA94574207Q00000X
NC2022-02592207Q00000X
FLME129873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine