Basic Information
| Provider Information | |||||||||
| NPI: | 1134174055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLEDGER | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | ROY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5900 LONG MEADOW DR | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450059687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134203773 | ||||||||
| FaxNumber: | 5137272539 | ||||||||
| Practice Location | |||||||||
| Address1: | 5900 LONG MEADOW DR | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450059687 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134203773 | ||||||||
| FaxNumber: | 5137272539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 02/04/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | 35-033951 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207X00000X | 35-033951 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0333151 | 05 | OH | MEDICAID |