Provider Demographics
NPI:1578530184
Name:STEVENS, FREDERICK HANSEN JR (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:HANSEN
Last Name:STEVENS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FREDERICK
Other - Middle Name:H
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7850 MEMORIAL PKWY SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-2224
Mailing Address - Country:US
Mailing Address - Phone:256-882-0132
Mailing Address - Fax:256-882-1461
Practice Address - Street 1:7850 MEMORIAL PKWY SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-2224
Practice Address - Country:US
Practice Address - Phone:256-882-0132
Practice Address - Fax:256-882-1461
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051511094OtherBLUE CROSS BLUE SHIELD
AL080194993OtherRAILROAD MEDICARE
AL000076547Medicare ID - Type Unspecified
C72833Medicare UPIN