Individual
S FRED STEPHENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6400 DUTCHMANS PKWY, SUITE 125, LOUISVILLE, KY 40205-3340
(502) 896-8700
(502) 896-0813
Mailing address
6400 DUTCHMANS PKWY, SUITE 125, LOUISVILLE, KY 40205-3340
(502) 896-8700
(502) 896-0813
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
19574
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000050467
ANTHEM BLUE CROSS BLUE SH
KY
05
—
64195746
—
KY
Enumeration date
09/07/2005
Last updated
11/02/2007
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