Provider Demographics
NPI:1699805119
Name:HEBERT, STEPHEN WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:HEBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2990 BETHESDA PL
Mailing Address - Street 2:SUITE 602-A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3318
Mailing Address - Country:US
Mailing Address - Phone:336-768-8281
Mailing Address - Fax:336-768-5685
Practice Address - Street 1:2990 BETHESDA PL
Practice Address - Street 2:SUITE 602-A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3318
Practice Address - Country:US
Practice Address - Phone:336-768-8281
Practice Address - Fax:336-768-5685
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC179892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8940889Medicaid
NC207147AMedicare ID - Type UnspecifiedPHYSICIAN
NCC84427Medicare UPIN