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General NPI Number Information
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NPI Number | 1548657067
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Entity Type | Individual
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Provider Name | PAUL R STEVENS MD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 4480 W SPENCER ST
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City | APPLETON
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State | WI
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Zip | 54914-9106
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Country | US
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Telephone | 920-738-4800
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Fax | 920-738-5749
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Provider Business Mailing Address
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Address Line | 3 NEENAH CTR
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City | NEENAH
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State | WI
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Zip | 54956-3070
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Country | US
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Telephone | 920-738-4800
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Fax | 920-738-5749
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 66341
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License Number State | WI
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