Basic Information
| Provider Information | |||||||||
| NPI: | 1215173034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHENS | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1028 MIAMISBURG CENTERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON TOWNSHIP | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454596700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374254020 | ||||||||
| FaxNumber: | 9374254029 | ||||||||
| Practice Location | |||||||||
| Address1: | 3131 QUEEN CITY AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452382316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135573333 | ||||||||
| FaxNumber: | 5135573332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2008 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 002860 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.