Provider Demographics
NPI:1275234254
Name:DEVENPORT, STEVEN
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:DEVENPORT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 45TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-3631
Mailing Address - Country:US
Mailing Address - Phone:806-577-5398
Mailing Address - Fax:
Practice Address - Street 1:3417 73RD ST STE 70
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1020
Practice Address - Country:US
Practice Address - Phone:806-577-5398
Practice Address - Fax:806-639-4337
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor