MEDICARE: DR. PEGGY S STEPHENS 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	2084P0800X	Psychiatry Physician	01038200	IN

General Provider Information

NPI Number	:	1699765115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEGGY S STEPHENS M.D.

Provider Business Mailing Address
First Line	:	12102 COVERED BRIDGE RD
Second Line	:
City	:	SELLERSBURG
State	:	IN
Zip	:	47172-9667
Country	:	US
Telephone Number	:	502-741-0313
Fax Number	:

Provider Business Practice Location Address
First Line	:	12102 COVERED BRIDGE RD
Second Line	:
City	:	SELLERSBURG
State	:	IN
Zip	:	47172-9667
Country	:	US
Telephone Number	:	502-741-0313
Fax Number	:

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	05/21/2020

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