Provider Demographics
NPI:1023179231
Name:STEPHENS, DAVID ROY (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROY
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 1:10687 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5727
Mailing Address - Country:US
Mailing Address - Phone:425-455-0444
Mailing Address - Fax:425-709-6863
Practice Address - Street 1:10687 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5727
Practice Address - Country:US
Practice Address - Phone:425-455-0444
Practice Address - Fax:425-709-6863
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033017208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE48214Medicare UPIN