Healthcare Provider Details

I. General information

NPI: 1528110095
Provider Name (Legal Business Name): STEPHEN BEPKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIRCLE DAVID GRANT MEDICAL CENTER
TRAVIS AFB CA
94535-1800
US

IV. Provider business mailing address

101 BODIN CIRCLE DAVID GRANT MEDICAL CENTER
TRAVIS AFB CA
94535-1800
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7273
  • Fax:
Mailing address:
  • Phone: 707-423-7273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberK5454
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: