Provider Demographics
NPI:1245205350
Name:STEVENS, EDWARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
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:PO BOX 8252
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64508-8252
Mailing Address - Country:US
Mailing Address - Phone:816-271-6575
Mailing Address - Fax:816-271-6139
Practice Address - Street 1:5325 FARAON ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3488
Practice Address - Country:US
Practice Address - Phone:816-271-6575
Practice Address - Fax:816-271-6139
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO276072085R0202X
KS04138282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO04682065OtherBCBS KANSAS CITY MO
KS470769OtherBCBS KS FOR MO LOCATION
KS106141OtherBCBS KS FOR KS LOCATION
KS106141Medicare PIN
KS470769OtherBCBS KS FOR MO LOCATION
MON481771Medicare PIN