Provider Demographics
NPI:1982684460
Name:DESTEPHENS, JAMES BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRUCE
Last Name:DESTEPHENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2341 NW 41ST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7494
Mailing Address - Country:US
Mailing Address - Phone:352-371-1804
Mailing Address - Fax:352-371-2033
Practice Address - Street 1:2341 NW 41ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7494
Practice Address - Country:US
Practice Address - Phone:352-371-1804
Practice Address - Fax:352-371-2033
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0045204207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC86508Medicare UPIN
FLK3786Medicare ID - Type UnspecifiedGROUP