Provider Demographics
NPI:1538287438
Name:STEVENS, WESLEY JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:JAMES
Last Name:STEVENS
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 1:535 S MAIN ST
Mailing Address - Street 2:P.O. BOX 11
Mailing Address - City:ALTURAS
Mailing Address - State:CA
Mailing Address - Zip Code:96101-4114
Mailing Address - Country:US
Mailing Address - Phone:530-233-2288
Mailing Address - Fax:530-233-1941
Practice Address - Street 1:535 S MAIN ST
Practice Address - Street 2:535 S MAIN ST
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101-4114
Practice Address - Country:US
Practice Address - Phone:530-233-2288
Practice Address - Fax:530-233-1941
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A3804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53852FMedicaid
CA020A38040Medicaid
CARHM53852FMedicaid
CA020A38040Medicaid
CA20A3804Medicare ID - Type Unspecified