Healthcare Provider Details

I. General information

NPI: 1164530382
Provider Name (Legal Business Name): MICHAEL A. STEPHENS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 PARK AVE
ORANGE PARK FL
32073-4946
US

IV. Provider business mailing address

1701 PARK AVE
ORANGE PARK FL
32073-4946
US

V. Phone/Fax

Practice location:
  • Phone: 904-510-2382
  • Fax: 904-407-7839
Mailing address:
  • Phone: 904-982-6453
  • Fax: 904-407-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ANTHONY STEPHENS
Title or Position: PHYSICIAN
Credential:
Phone: 904-510-2382