Provider Demographics
NPI:1891770061
Name:STEVENS, ERIC C (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:C
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:601 WEST SECOND STREET
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47402-2317
Practice Address - Country:US
Practice Address - Phone:812-336-6821
Practice Address - Fax:419-866-5453
Is Sole Proprietor?:No
Enumeration Date:2005-12-10
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01054099A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
220031685OtherRAILROAD
IN185220EMedicare UPIN
INH52237Medicare UPIN