MEDICARE: STEPHEN DOUGLAS DEFRANC ATHLETIC TRAINER

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	174400000X	Specialist	1536	MA

General Provider Information

NPI Number	:	1164496089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN DOUGLAS DEFRANC ATHLETIC TRAINER

Provider Business Mailing Address
First Line	:	20 SEAL COVE RD
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2083
Country	:	US
Telephone Number	:	508-224-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 ACADEMY DR
Second Line	:	MASSACHUSETTS MARITIME ACADEMY
City	:	BUZZARDS BAY
State	:	MA
Zip	:	02532-3405
Country	:	US
Telephone Number	:	781-337-7500
Fax Number	:

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	07/08/2007

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