Healthcare Provider Details

I. General information

NPI: 1902871981
Provider Name (Legal Business Name): CRAIG A. STEVENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 OLIVE CHAPEL RD STE 107
APEX NC
27502-8587
US

IV. Provider business mailing address

106 RIDGE VIEW DR SUITE A
CARY NC
27511-6647
US

V. Phone/Fax

Practice location:
  • Phone: 630-740-0574
  • Fax:
Mailing address:
  • Phone: 919-319-6363
  • Fax: 919-319-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number97-00773
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier891047R
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: