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Dr. Brian T Stephens
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NPI Number Detailed Information
Provider Information:
| Name: | Dr. Brian T Stephens |
| Gender: | M |
| Provider License Number If Given: | MD2001008551 |
NPI Information:
| NPI: | 1760485718 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 5/23/2005 |
| Last Update Date: | 4/18/2013 |
Provider Business Mailing Address:
| Address: | PO BOX 104240 Jefferson City, MO 65110 |
| Phone Number: | 5736355264 |
| Fax Number: |
Provider Business Practice Location Address:
| Address: | 1241 W STADIUM BLVD Jefferson City, MO 65109 |
| Phone Number: | 5736365248 |
| Fax Number: | 5736369390 |
Provider Taxonomy:
| Primary: | 174400000X |
| Secondary (if any): | |
| State: | MO |
