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Individual

DR. JONATHAN CRAIG STEVENS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
105 VERMEER DR UNIT 1, PONDERAY, ID 83852-9802
(208) 266-1677
(208) 266-0440
Mailing address
PO BOX 353, CLARK FORK, ID 83811
(208) 266-1677
(208) 266-0440

Taxonomy

Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
M7507
ID
208100000X
Physical Medicine & Rehabilitation Physician
M7507
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
805192200
ID
Enumeration date
05/19/2006
Last updated
07/21/2022
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