Individual
MR. PHILLIP E STEVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1441 NE 10TH AVE, PAYETTE, ID 83661-5420
(208) 642-9376
(208) 642-9598
Mailing address
1441 NE 10TH AVE, PAYETTE, ID 83661-5420
(208) 642-9376
(208) 642-9598
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PENDING
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012345
LICENSE PENDING
ID
05
—
808211700
—
ID
05
—
808211701
—
ID
05
—
808211702
—
ID
Enumeration date
10/01/2008
Last updated
12/01/2008
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