Healthcare Provider Details

I. General information

NPI: 1942795182
Provider Name (Legal Business Name): JAMES DEVIN STEPHENSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

858 MONUMENT RD STE A
JACKSONVILLE FL
32225-6684
US

IV. Provider business mailing address

858 MONUMENT RD STE A
JACKSONVILLE FL
32225-6684
US

V. Phone/Fax

Practice location:
  • Phone: 904-450-8060
  • Fax: 904-450-6969
Mailing address:
  • Phone: 904-450-8060
  • Fax: 904-450-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS16777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: