Provider Demographics
NPI:1417982760
Name:FERN, STEVEN E (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:E
Last Name:FERN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 MATTOX DR
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-2365
Mailing Address - Country:US
Mailing Address - Phone:573-860-6000
Mailing Address - Fax:
Practice Address - Street 1:965 MATTOX DR
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-2365
Practice Address - Country:US
Practice Address - Phone:573-860-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8P03207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100017272OtherRAILROAD MEDICARE
136256OtherGHP
19561OtherBLUE CROSS/BLUE SHIELD
4668959OtherAETNA
1441643OtherUHC
MO006012657OtherMEDICARE LEGACY
270559OtherHEALTHLINK
MO247962921Medicaid
MO247962921Medicaid