Provider Demographics
NPI:1730377607
Name:AGANS, STEPHEN CARL (MD/MPH)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CARL
Last Name:AGANS
Suffix:
Gender:M
Credentials:MD/MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 LINDELL BLVD
Mailing Address - Street 2:311
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3725
Mailing Address - Country:US
Mailing Address - Phone:504-352-7856
Mailing Address - Fax:
Practice Address - Street 1:1101 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3147
Practice Address - Country:US
Practice Address - Phone:504-347-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202374207P00000X
LAPGY.1.LSUNO-EMR207PE0004X
MO2023006574207PE0005X
MS21347207PE0005X
LA2023742083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1004871Medicaid
MS02437244Medicaid
LAPGY.1.LSUNO-EMROtherLSBME
LA1004871Medicaid