Healthcare Provider Details

I. General information

NPI: 1013145531
Provider Name (Legal Business Name): MARK JOSEPH STEVENS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9204 MENAUL BLVD NE STE 6
ALBUQUERQUE NM
87112-2201
US

IV. Provider business mailing address

9204 MENAUL BLVD NE STE 6
ALBUQUERQUE NM
87112-2201
US

V. Phone/Fax

Practice location:
  • Phone: 505-261-4554
  • Fax: 505-485-0423
Mailing address:
  • Phone: 505-361-4554
  • Fax: 505-485-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2171
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA-1757-13
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: