Individual
BRENT STEPHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
205 E NASA BLVD, MELBOURNE, FL 32901-1950
(321) 361-5626
(321) 723-9176
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 361-5626
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME119690
FL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
ME119690
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012130500
—
FL
01
—
14V76
BCBS
FL
01
—
HW451X
MEDICARE
FL
01
—
HW451Y
HFPSI MEDICARE
FL
Enumeration date
07/15/2009
Last updated
09/06/2023
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