Provider Demographics
NPI:1942604038
Name:STEPHENS, RALPH WESLEY (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:WESLEY
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 HARVEY LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3528
Mailing Address - Country:US
Mailing Address - Phone:775-826-0925
Mailing Address - Fax:
Practice Address - Street 1:1137 HARVEY LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3528
Practice Address - Country:US
Practice Address - Phone:775-826-0925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMED-LIC-2408207W00000X
MTMED-PHYS-LIC-3094207W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice