Healthcare Provider Details

I. General information

NPI: 1205001229
Provider Name (Legal Business Name): DENNIS R STEVENSON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 EDINBURGH DR
WINTER PARK FL
32792-4100
US

IV. Provider business mailing address

101 EDINBURGH DR
WINTER PARK FL
32792-4100
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-6886
  • Fax: 407-647-2431
Mailing address:
  • Phone: 407-647-6886
  • Fax: 407-647-2431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME0050905
License Number StateFL

VIII. Authorized Official

Name: DR. DENNIS R STEVENSON
Title or Position: PRESIDENT/PHYSICIAN
Credential: MD
Phone: 407-647-6886