Healthcare Provider Details

I. General information

NPI: 1497168637
Provider Name (Legal Business Name): STEPHEN HOUMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BURMA AVE
GILLETTE WY
82716-3426
US

IV. Provider business mailing address

PO BOX 245057 UNIVERSITY OF ARIZONA DEPT OF EMERGENCY MEDICINE
TUCSON AZ
85724-5057
US

V. Phone/Fax

Practice location:
  • Phone: 307-688-1000
  • Fax:
Mailing address:
  • Phone: 520-626-7233
  • Fax: 520-626-1633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR74359
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: