Healthcare Provider Details

I. General information

NPI: 1407176175
Provider Name (Legal Business Name): ROBERT B STEVENS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-8100
  • Fax: 207-873-8101
Mailing address:
  • Phone: 207-873-8100
  • Fax: 207-873-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDO2398
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: