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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

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