Provider Demographics
NPI:1821093758
Name:STEVENS, SCOTT P (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:P
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-962-6053
Mailing Address - Fax:765-935-7401
Practice Address - Street 1:1050 REID PKWY STE 120
Practice Address - Street 2:GENERAL SURGEONS
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1156
Practice Address - Country:US
Practice Address - Phone:765-962-6053
Practice Address - Fax:765-935-7401
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055751208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000705025OtherANTHEM
IN200364440Medicaid
INH54629Medicare UPIN
IN200364440Medicaid