Healthcare Provider Details

I. General information

NPI: 1336248335
Provider Name (Legal Business Name): JOHN REGIS STEVENSON D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8721 N MAIN ST
DAYTON OH
45415-1331
US

IV. Provider business mailing address

6200 PLEASANT AVE SUITE 3
FAIRFIELD OH
45014-4670
US

V. Phone/Fax

Practice location:
  • Phone: 937-264-3150
  • Fax: 513-858-7827
Mailing address:
  • Phone: 937-435-6585
  • Fax: 937-435-6563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36002504
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: