Provider Demographics
NPI:1740366988
Name:STEPHENSON, PATRICIA J (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 N. NORTERRA DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-8200
Mailing Address - Country:US
Mailing Address - Phone:623-277-1130
Mailing Address - Fax:602-906-2789
Practice Address - Street 1:13041 N DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3034
Practice Address - Country:US
Practice Address - Phone:623-977-7201
Practice Address - Fax:602-906-2789
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD4910207Q00000X
AZ46190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0040235OtherBCBS
SD4992942OtherWELLMARK
SD4910OtherDAKOTA CARE
SDP00406997OtherRR MEDICARE
H51581Medicare UPIN
SD5610972Medicaid
SD5610974Medicaid
SDS100553Medicare ID - Type Unspecified
SDS101801Medicare PIN