Healthcare Provider Details

I. General information

NPI: 1063456036
Provider Name (Legal Business Name): GREGORY W STEPHENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE #404
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2123 AUBURN AVE #404
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-241-5630
  • Fax: 513-241-7146
Mailing address:
  • Phone: 513-241-5630
  • Fax: 513-241-7146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35-05-3679-S
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number27566
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: