Basic Information
| Provider Information | |||||||||
| NPI: | 1407143670 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEPHENS | ||||||||
| FirstName: | ALEXIS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 SOUTHHALL LN | ||||||||
| Address2: | STE 300 | ||||||||
| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327517172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078752080 | ||||||||
| FaxNumber: | 4076503455 | ||||||||
| Practice Location | |||||||||
| Address1: | 4331 N FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | OAKLAND PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333085211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547720416 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2011 | ||||||||
| LastUpdateDate: | 09/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | OS11837 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.