Provider Demographics
NPI:1730126335
Name:STEVENS, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:STEVENS
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 1:3700 NW CARY PKWY
Mailing Address - Street 2:STE 110
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8446
Mailing Address - Country:US
Mailing Address - Phone:919-238-2000
Mailing Address - Fax:
Practice Address - Street 1:3700 NW CARY PKWY
Practice Address - Street 2:STE 110
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8446
Practice Address - Country:US
Practice Address - Phone:919-238-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39104207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC79825OtherBCBS
E13431Medicare UPIN
NC2150006HMedicare ID - Type Unspecified