MEDICARE: DR. ROBERT LEE STEPHENSON 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	207R00000X	Internal Medicine Physician	G65902	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G65902	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1386642478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT LEE STEPHENSON M.D.

Provider Business Mailing Address
First Line	:	320 SANTA FE DR
Second Line	:	SUITE 303
City	:	ENCINITAS
State	:	CA
Zip	:	92024-5138
Country	:	US
Telephone Number	:	760-943-6730
Fax Number	:	760-943-6733

Provider Business Practice Location Address
First Line	:	320 SANTA FE DR
Second Line	:	SUITE 303
City	:	ENCINITAS
State	:	CA
Zip	:	92024-5138
Country	:	US
Telephone Number	:	760-943-6730
Fax Number	:	760-943-6733

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	11/01/2011

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