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Individual

BRYON J. STEPHENS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
7910 W JEFFERSON BLVD, SUITE 112, FORT WAYNE, IN 46804-4159
(260) 969-7121
(260) 436-4292
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01040106A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0998112
OH
05
100082280
IN
05
103410227
MI
01
P00919721
RAILROAD MEDICARE
IN
Enumeration date
08/02/2005
Last updated
09/30/2020
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