Provider Demographics
NPI:1013958644
Name:MCDAVID, STEPHEN T (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:T
Last Name:MCDAVID
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-7576
Mailing Address - Fax:228-497-8869
Practice Address - Street 1:3109 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4361
Practice Address - Country:US
Practice Address - Phone:228-818-1158
Practice Address - Fax:228-762-3147
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS17316207Q00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000125627Medicaid
MSH58676Medicare UPIN
MS080003551Medicare ID - Type UnspecifiedMEDICARE IND PROV #