Provider Demographics
NPI:1518259498
Name:STEFFEN, KEVIN DEAN JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DEAN
Last Name:STEFFEN
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 WEST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-4510
Mailing Address - Country:US
Mailing Address - Phone:870-580-5589
Mailing Address - Fax:870-580-5590
Practice Address - Street 1:806 WEST RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4510
Practice Address - Country:US
Practice Address - Phone:870-580-5589
Practice Address - Fax:870-580-5590
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR257213ES0103X
AR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1518259498Medicaid
AR205186717Medicaid