Provider Demographics
NPI:1033147285
Name:STEVENS, DANIEL MERRICK (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MERRICK
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 N ST
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1623
Mailing Address - Country:US
Mailing Address - Phone:308-728-9916
Mailing Address - Fax:308-728-3274
Practice Address - Street 1:1820 N ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1623
Practice Address - Country:US
Practice Address - Phone:308-728-9916
Practice Address - Fax:308-728-3274
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE35859OtherBCBS
NE47084643200Medicaid
NEBS1760823OtherDEA
NE099142Medicare ID - Type UnspecifiedGROUP
NE275004Medicare ID - Type UnspecifiedINDIVIDUAL
NEE35729Medicare UPIN