Healthcare Provider Details

I. General information

NPI: 1801888607
Provider Name (Legal Business Name): MICHAEL ANTHONY STEPHENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 PARK AVE STE A
ORANGE PARK FL
32073-4112
US

IV. Provider business mailing address

1701 PARK AVE
ORANGE PARK FL
32073-4946
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-2092
  • Fax: 904-376-4075
Mailing address:
  • Phone: 904-510-2382
  • Fax: 904-407-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME64230
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: