Provider Demographics
NPI:1164496089
Name:DEFRANC, STEPHEN DOUGLAS (ATHLETIC TRAINER)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:DEFRANC
Suffix:
Gender:M
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SEAL COVE RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2083
Mailing Address - Country:US
Mailing Address - Phone:508-224-9199
Mailing Address - Fax:
Practice Address - Street 1:101 ACADEMY DR
Practice Address - Street 2:MASSACHUSETTS MARITIME ACADEMY
Practice Address - City:BUZZARDS BAY
Practice Address - State:MA
Practice Address - Zip Code:02532-3405
Practice Address - Country:US
Practice Address - Phone:781-337-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1536174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist