Provider Demographics
NPI:1215525936
Name:STEPHAN, ROBERT ANTHONY JR
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTHONY
Last Name:STEPHAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1262
Mailing Address - Country:US
Mailing Address - Phone:907-729-8901
Mailing Address - Fax:907-729-6353
Practice Address - Street 1:101 INDIAN CREEK RD
Practice Address - Street 2:
Practice Address - City:TYONEK
Practice Address - State:AK
Practice Address - Zip Code:99682
Practice Address - Country:US
Practice Address - Phone:907-583-2461
Practice Address - Fax:907-583-2115
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker