MEDICARE: LARRY E. STEVENS, M.D.

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1932402955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARRY E. STEVENS, M.D.

Provider Business Mailing Address
First Line	:	120 STATE ST E STE 106
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-3647
Country	:	US
Telephone Number	:	813-855-2969
Fax Number	:	813-891-6931

Provider Business Practice Location Address
First Line	:	120 STATE ST E STE 106
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-3647
Country	:	US
Telephone Number	:	813-855-2969
Fax Number	:	813-891-6931

Authorized Official
Title or Position	:	BILLING OWNER
Name	:	MS. CHERYL LYNN E SWEENEY
Credential	:
Telephone Number	:	727-289-6326

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	12/14/2010

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