Provider Demographics
NPI:1710962725
Name:STEVENS, VICTORIA MARY (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARY
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5860 S HOSPITAL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-9449
Mailing Address - Country:US
Mailing Address - Phone:928-425-3193
Mailing Address - Fax:928-425-4771
Practice Address - Street 1:5860 S HOSPITAL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-9449
Practice Address - Country:US
Practice Address - Phone:928-425-3193
Practice Address - Fax:928-425-4771
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11938207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ235342Medicaid
AZ20WCGDT02Medicare ID - Type Unspecified
AZ235342Medicaid
AZ0733210001Medicare NSC