Individual
STEPHEN E STEVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11400 158TH RD, MAYETTA, KS 66509-8866
(785) 966-8200
(785) 966-8200
Mailing address
11400 158TH RD, MAYETTA, KS 66509-8866
(785) 966-8200
(785) 966-8200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-22751
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-22751
KS ST BOARD OF HEALING AR
KS
01
—
17D0668588
CLIA CERTIFICATE
KS
05
—
200259300A
—
KS
01
—
38375
STATE OF COLORADO
CO
Enumeration date
06/28/2006
Last updated
03/07/2023
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