Provider Demographics
NPI:1942298179
Name:STEVENSON, DENNIS R (MD)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:R
Last Name:STEVENSON
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 1:101 EDINBURGH DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4100
Mailing Address - Country:US
Mailing Address - Phone:407-647-6886
Mailing Address - Fax:407-647-2431
Practice Address - Street 1:101 EDINBURGH DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4100
Practice Address - Country:US
Practice Address - Phone:407-647-6886
Practice Address - Fax:407-647-2431
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050905207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257453500Medicaid
FL257453500Medicaid
FL04052AMedicare ID - Type Unspecified