Provider Demographics
NPI:1881833275
Name:STEVENS, KEITH LINN (LAC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LINN
Last Name:STEVENS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-0051
Mailing Address - Country:US
Mailing Address - Phone:209-354-4199
Mailing Address - Fax:209-354-4198
Practice Address - Street 1:1190 W OLIVE AVE
Practice Address - Street 2:SUITE G
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1960
Practice Address - Country:US
Practice Address - Phone:209-354-4199
Practice Address - Fax:209-354-4198
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine