Individual
GERALD STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
31872 SOUTH COAST HIGHWAY, LAGUNA BEACH, CA 92651
(949) 499-7195
Mailing address
DEPT LA 21650, PASADENA, CA 91185-1650
(949) 263-8620
(949) 263-1639
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A42565
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A426570
BLUE SHIELD
CA
Enumeration date
05/17/2006
Last updated
11/30/2007
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