Provider Demographics
NPI:1417279068
Name:STEVENS, RYAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:A
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14275 N 87TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3696
Mailing Address - Country:US
Mailing Address - Phone:480-905-8485
Mailing Address - Fax:480-905-7274
Practice Address - Street 1:18699 N 67TH AVE STE 220
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:480-905-8485
Practice Address - Fax:480-905-7274
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50626207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology