Provider Demographics
NPI:1639213101
Name:JAMES B DESTEPHENS MD PA
Entity Type:Organization
Organization Name:JAMES B DESTEPHENS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:DESTEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-371-1804
Mailing Address - Street 1:2341 NW 41ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7442
Mailing Address - Country:US
Mailing Address - Phone:352-371-1804
Mailing Address - Fax:352-371-2033
Practice Address - Street 1:2341 NW 41ST ST STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7442
Practice Address - Country:US
Practice Address - Phone:352-371-1804
Practice Address - Fax:352-371-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045204207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL175709OtherBLACK LUNG
FL1982684460OtherNPI ATTACHED TO SS NO
FLK3786Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FL01387YMedicare ID - Type UnspecifiedPROVIDER NUMBER
FL1982684460OtherNPI ATTACHED TO SS NO