Healthcare Provider Details

I. General information

NPI: 1245267715
Provider Name (Legal Business Name): STEPHEN E STEVENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 158TH RD
MAYETTA KS
66509-8866
US

IV. Provider business mailing address

11400 158TH RD
MAYETTA KS
66509-8866
US

V. Phone/Fax

Practice location:
  • Phone: 785-966-8200
  • Fax: 785-966-8200
Mailing address:
  • Phone: 785-966-8200
  • Fax: 785-966-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-22751
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: