Provider Demographics
NPI:1013142231
Name:STEPHENSON, JOSHUA DOUGLAS (SO IDMT, NR-P)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:DOUGLAS
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:SO IDMT, NR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MATERO DRIVE
Mailing Address - Street 2:
Mailing Address - City:POPE FIELD
Mailing Address - State:NC
Mailing Address - Zip Code:28308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3051 BLAKE STREET
Practice Address - Street 2:
Practice Address - City:DUKE FIELD
Practice Address - State:FL
Practice Address - Zip Code:32542
Practice Address - Country:US
Practice Address - Phone:850-885-3067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic