Healthcare Provider Details

I. General information

NPI: 1184720765
Provider Name (Legal Business Name): JAMES ERNEST STEPHENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 E NATIONAL AVE 90A
BRAZIL IN
47834-2700
US

IV. Provider business mailing address

3747 W COUNTY ROAD 600 N
BRAZIL IN
47834-7434
US

V. Phone/Fax

Practice location:
  • Phone: 812-442-2900
  • Fax:
Mailing address:
  • Phone: 812-448-2024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01028695
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01028695
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: