MEDICARE: DR. LEO M STEVENSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	631472211205	UT
2	207VG0400X	Gynecology Physician	631472211205	UT

General Provider Information

NPI Number	:	1740245620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEO M STEVENSON MD

Provider Business Mailing Address
First Line	:	555 E 5300 S #7
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-4509
Country	:	US
Telephone Number	:	801-621-1781
Fax Number	:	801-621-6994

Provider Business Practice Location Address
First Line	:	555 E 5300 S #7
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84405-4509
Country	:	US
Telephone Number	:	801-621-1781
Fax Number	:	801-621-6994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	09/11/2025

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