Healthcare Provider Details

I. General information

NPI: 1396907770
Provider Name (Legal Business Name): J ANTHONY STEPHENS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5233 DIJON DR
BATON ROUGE LA
70808-4692
US

IV. Provider business mailing address

5233 DIJON DR
BATON ROUGE LA
70808-4692
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-7575
  • Fax: 225-768-7470
Mailing address:
  • Phone: 225-767-7575
  • Fax: 225-768-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD021285
License Number StateLA

VIII. Authorized Official

Name: JAMES ANTHONY STEPHENS
Title or Position: MEDICAL DOCTOR
Credential:
Phone: 225-767-7575