MEDICARE: MICHAEL STEPHENS FAMILY PRACTICE INC.

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1275682395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL STEPHENS FAMILY PRACTICE INC.

Provider Business Mailing Address
First Line	:	4495 ROOSEVELT BLVD
Second Line	:	SUITE 316
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3375
Country	:	US
Telephone Number	:	904-384-5222
Fax Number	:	904-384-6468

Provider Business Practice Location Address
First Line	:	4495 ROOSEVELT BLVD
Second Line	:	SUITE 316
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3375
Country	:	US
Telephone Number	:	904-384-5222
Fax Number	:	904-384-6468

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL A STEPHENS
Credential	:	M.D.
Telephone Number	:	904-384-5222

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/01/2025

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