Healthcare Provider Details

I. General information

NPI: 1376535880
Provider Name (Legal Business Name): STEPHEN B SEXSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7436 GLENVISTA PL
FISHERS IN
46038-1190
US

IV. Provider business mailing address

7436 GLENVISTA PL
FISHERS IN
46038-1190
US

V. Phone/Fax

Practice location:
  • Phone: 317-845-0889
  • Fax:
Mailing address:
  • Phone: 317-845-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number01033281A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01033281A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: