Provider Demographics
NPI:1710087556
Name:STEPHENS, ROY J SR
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:J
Last Name:STEPHENS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9885 WINEGAR RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-8231
Mailing Address - Country:US
Mailing Address - Phone:530-221-4321
Mailing Address - Fax:530-224-1238
Practice Address - Street 1:1655 E CYPRESS AVE STE 3
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1345
Practice Address - Country:US
Practice Address - Phone:530-221-4321
Practice Address - Fax:530-224-1238
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ78397ZMedicaid