MEDICARE: DR. FRAZIER T. STEVENSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	G059677	CA
2	207RN0300X	Nephrology Physician	ME 107406	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G059677	OTHER	CA	MEDICAL LICENSE
2	ME 107406	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1114902657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRAZIER T. STEVENSON M.D.

Provider Business Mailing Address
First Line	:	12901 BRUCE B DOWNS BLVD
Second Line	:	MDC54 USF COM
City	:	TAMPA
State	:	FL
Zip	:	33612-4742
Country	:	US
Telephone Number	:	813-974-7131
Fax Number	:

Provider Business Practice Location Address
First Line	:	12901 BRUCE B DOWNS BLVD
Second Line	:	MDC54 USF COM
City	:	TAMPA
State	:	FL
Zip	:	33612-4742
Country	:	US
Telephone Number	:	813-974-7131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	07/14/2010

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Directions to “ DR. FRAZIER T. STEVENSON M.D.” Practice Location

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