Provider Demographics
NPI:1922113364
Name:STEPHENS, DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
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 1:2587 MERCED ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4207
Mailing Address - Country:US
Mailing Address - Phone:510-351-3553
Mailing Address - Fax:510-351-3585
Practice Address - Street 1:2587 MERCED ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4207
Practice Address - Country:US
Practice Address - Phone:510-351-3553
Practice Address - Fax:510-351-3585
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACK572UMedicare UPIN
CACK572YMedicare UPIN
CACK572RMedicare UPIN
CACK572XMedicare UPIN
I47297Medicare UPIN
CACK572VMedicare UPIN
CACK572ZMedicare UPIN
WA66374BMedicare ID - Type UnspecifiedMEDICARE PART B PPIN
CK572WMedicare UPIN