Provider Demographics
NPI:1851624860
Name:STEVENS, ANDREW (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W PORPHYRY ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2312
Mailing Address - Country:US
Mailing Address - Phone:406-723-0043
Mailing Address - Fax:406-723-2067
Practice Address - Street 1:400 W PORPHYRY ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2312
Practice Address - Country:US
Practice Address - Phone:406-723-0043
Practice Address - Fax:406-723-2067
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT70948208600000X
OHFS14351895869208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice