Provider Demographics
NPI:1083747612
Name:CALVERT, STEPHEN EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EUGENE
Last Name:CALVERT
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 1:459 N JENIFER AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2732
Mailing Address - Country:US
Mailing Address - Phone:626-264-2424
Mailing Address - Fax:
Practice Address - Street 1:3742 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1704
Practice Address - Country:US
Practice Address - Phone:323-780-4100
Practice Address - Fax:323-780-4110
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30899208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice