Provider Demographics
NPI:1083651343
Name:GOEWEY, STEPHEN KENNETH (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:KENNETH
Last Name:GOEWEY
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:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063
Mailing Address - Country:US
Mailing Address - Phone:731-221-1637
Mailing Address - Fax:731-221-3028
Practice Address - Street 1:326 ASBURY AVE
Practice Address - Street 2:STE 101
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063
Practice Address - Country:US
Practice Address - Phone:731-221-1637
Practice Address - Fax:731-221-3028
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39270207Q00000X
TN39270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3325722Medicaid
H73896Medicare UPIN
TN3325722Medicare PIN
TN3325722Medicaid