Provider Demographics
NPI:1982052130
Name:STEVERSON, REBEKAH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:ANN
Last Name:STEVERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12427
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317
Mailing Address - Country:US
Mailing Address - Phone:850-681-3887
Mailing Address - Fax:850-681-0569
Practice Address - Street 1:1205 MARION AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303
Practice Address - Country:US
Practice Address - Phone:850-681-3887
Practice Address - Fax:850-681-0569
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA267382208000000X
FLME144152208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105891500Medicaid