Provider Demographics
NPI:1740297175
Name:REPLOGLE, STEPHEN (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:REPLOGLE
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 1:11871 S FORTUNA RD
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-7686
Mailing Address - Country:US
Mailing Address - Phone:928-342-9020
Mailing Address - Fax:928-342-2158
Practice Address - Street 1:11871 S FORTUNA RD
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-7686
Practice Address - Country:US
Practice Address - Phone:928-342-9020
Practice Address - Fax:928-342-2158
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2757208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ71915Medicare ID - Type UnspecifiedMEDICARE
AZF10800Medicare UPIN