Healthcare Provider Details

I. General information

NPI: 1306005988
Provider Name (Legal Business Name): FREDERICK STEPHENS II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FREDERICK L STEPHENS MD

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CTR 9040 JACSKON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CTR NEUROSURGERY DEPARTMENT
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberC54754
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD60302866
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number01057415A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: