Provider Demographics
NPI:1962628982
Name:STEVENS, VICTOR LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:LOUIS
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 1:143 ALABASTER
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-2820
Mailing Address - Country:US
Mailing Address - Phone:210-945-0267
Mailing Address - Fax:210-945-0267
Practice Address - Street 1:120 DAVID WADE DR
Practice Address - Street 2:DEVEREUX VICTORIA RTC
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77902-2666
Practice Address - Country:US
Practice Address - Phone:361-575-8271
Practice Address - Fax:361-575-6520
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK02072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103705301Medicaid
TX103705301Medicaid
TX8L13780Medicare UPIN