Healthcare Provider Details

I. General information

NPI: 1134170806
Provider Name (Legal Business Name): RICK BRIAN STEVENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5149 N 9TH AVE STE 246
PENSACOLA FL
32504-8755
US

IV. Provider business mailing address

988095 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8095
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-1080
  • Fax: 850-416-1075
Mailing address:
  • Phone: 402-559-9800
  • Fax: 402-559-9840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number125474
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: