MEDICARE: DR. STEPHEN PACKER MD

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	207L00000X	Anesthesiology Physician	A201373	CA
2	207L00000X	Anesthesiology Physician	22027	NV
3	207L00000X	Anesthesiology Physician	ME147091	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87013	OTHER	GA	MEDICAL BOARD
2	ME147091	OTHER	FL	MEDICAL BOARD
3	62203	OTHER	TN	MEDICAL BOARD
4	22027	OTHER	NV	MEDICAL BOARD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487195756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN PACKER MD

Provider Business Mailing Address
First Line	:	3500 POSNER BLVD # 1277
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-3640
Country	:	US
Telephone Number	:	725-222-0807
Fax Number	:	707-666-6480

Provider Business Practice Location Address
First Line	:	2527 WILDBROOK AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1548
Country	:	US
Telephone Number	:	725-222-0807
Fax Number	:	707-666-6480

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

Provider Enumeration Date	:	03/20/2017
Last Update Date	:	09/26/2025

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Directions to “ DR. STEPHEN PACKER MD” Practice Location

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