MEDICARE: ALEXIS STEPHENS D.O.

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	207N00000X	Dermatology Physician	OS11837	FL

General Provider Information

NPI Number	:	1407143670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS STEPHENS D.O.

Provider Business Mailing Address
First Line	:	151 SOUTHHALL LN
Second Line	:	STE 300
City	:	MAITLAND
State	:	FL
Zip	:	32751-7172
Country	:	US
Telephone Number	:	407-875-2080
Fax Number	:	407-650-3455

Provider Business Practice Location Address
First Line	:	4331 N FEDERAL HWY
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33308-5211
Country	:	US
Telephone Number	:	954-772-0416
Fax Number	:

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

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	09/19/2016

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