MEDICARE: DR. LEE 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	2084P0800X	Psychiatry Physician	10120R	LA
2	2084P0800X	Psychiatry Physician	10160R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15-46377	OTHER		UNITED BEHAVIORAL
2	Z58612	OTHER	MA	BLUE CROSS OF MASS
3	721351593001	OTHER		HUMANA MILITARY
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	005742285990	OTHER		CIGNA
7	295065	OTHER	TX	TEXAS CHIP
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982634390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE STEVENS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5498
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71171-5498
Country	:	US
Telephone Number	:	318-422-7154
Fax Number	:	850-203-1488

Provider Business Practice Location Address
First Line	:	1007 GOULD DR STE 1
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-4971
Country	:	US
Telephone Number	:	318-422-7154
Fax Number	:	850-203-1448

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	09/28/2023

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Directions to “ DR. LEE STEVENS M.D.” Practice Location

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