Individual
DR. MARK KERRY STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
130 GOFF MOUNTAIN RD, CROSS LANES, WV 25313-1419
(304) 388-7070
(304) 388-7075
Mailing address
314 GOFF MOUNTAIN RD, STE 3, CROSS LANES, WV 25313-6600
(304) 388-7782
(304) 388-7788
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
14020
WV
207R00000X
Internal Medicine Physician
14020
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0070668000
—
WV
01
—
930063432
RAILROAD MEDICARE
—
Enumeration date
04/14/2006
Last updated
10/26/2017
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