Provider Demographics
NPI:1801888607
Name:STEPHENS, MICHAEL ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-376-4075
Practice Address - Street 1:1008 PARK AVE STE A
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4112
Practice Address - Country:US
Practice Address - Phone:904-202-2092
Practice Address - Fax:904-376-4075
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2025-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME64230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00469531OtherRAILROAD MEDICARE
FLP00469531OtherRAILROAD MEDICARE
FLF90354Medicare UPIN