Healthcare Provider Details

I. General information

NPI: 1467447565
Provider Name (Legal Business Name): JAMES H. STEVENS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 MAR WALT DR
FT WALTON BEACH FL
32547-6645
US

IV. Provider business mailing address

2234 COLONIAL BLVD
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 850-863-5294
  • Fax: 850-864-1648
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME0068163
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: