Provider Demographics
NPI:1770017683
Name:STEVENS, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 N NEVADA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5307
Mailing Address - Country:US
Mailing Address - Phone:719-473-3272
Mailing Address - Fax:719-389-1191
Practice Address - Street 1:2312 N NEVADA AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5307
Practice Address - Country:US
Practice Address - Phone:719-473-3272
Practice Address - Fax:719-389-1191
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1726142084N0400X
CO711212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology