Provider Demographics
NPI:1295761245
Name:STEPHENS, BRIAN LAYNE (MD)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:LAYNE
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PMB 321
Mailing Address - Street 2:4320 DEERWOOD LAKE PKWY #101
Mailing Address - City:JAX
Mailing Address - State:FL
Mailing Address - Zip Code:32216
Mailing Address - Country:US
Mailing Address - Phone:904-371-4051
Mailing Address - Fax:888-745-5445
Practice Address - Street 1:3840 BELFORT RD
Practice Address - Street 2:#102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8207
Practice Address - Country:US
Practice Address - Phone:904-371-4051
Practice Address - Fax:888-745-5445
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-11-22
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Provider Licenses
StateLicense IDTaxonomies
FLME88496207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI00526Medicare UPIN
FL81829YMedicare PIN