Healthcare Provider Details

I. General information

NPI: 1114902657
Provider Name (Legal Business Name): FRAZIER T. STEVENSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 BRUCE B DOWNS BLVD MDC54 USF COM
TAMPA FL
33612-4742
US

IV. Provider business mailing address

12901 BRUCE B DOWNS BLVD MDC54 USF COM
TAMPA FL
33612-4742
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-7131
  • Fax:
Mailing address:
  • Phone: 813-974-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG059677
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME 107406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: