Provider Demographics
NPI:1891763918
Name:STEPHENS, DOYLE L (MD)
Entity Type:Individual
Prefix:
First Name:DOYLE
Middle Name:L
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 N BENTON RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-9548
Mailing Address - Country:US
Mailing Address - Phone:765-281-2000
Mailing Address - Fax:765-281-2062
Practice Address - Street 1:2401 W UNIVERSITY AVE
Practice Address - Street 2:CANCER CENTER
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3428
Practice Address - Country:US
Practice Address - Phone:765-281-2000
Practice Address - Fax:765-281-2062
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024996A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC24608Medicare UPIN
IN465610CMedicare ID - Type Unspecified