Provider Demographics
NPI:1467443499
Name:LAVERSON, STEVE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:
Last Name:LAVERSON
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 1:11199 SORRENTO VALLEY RD
Mailing Address - Street 2:#202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1334
Mailing Address - Country:US
Mailing Address - Phone:858-295-4001
Mailing Address - Fax:
Practice Address - Street 1:11199 SORRENTO VALLEY RD
Practice Address - Street 2:#202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1334
Practice Address - Country:US
Practice Address - Phone:858-295-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53607208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG53607Medicaid
CAG53607Medicare ID - Type Unspecified
CAF53199Medicare UPIN