Provider Demographics
NPI:1255943635
Name:FROST, STEPHON PEYTON (SFIDC)
Entity type:Individual
Prefix:
First Name:STEPHON
Middle Name:PEYTON
Last Name:FROST
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280046
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32228-0046
Mailing Address - Country:US
Mailing Address - Phone:904-270-3806
Mailing Address - Fax:
Practice Address - Street 1:2654 MENDONCA DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4263
Practice Address - Country:US
Practice Address - Phone:518-961-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman