Provider Demographics
NPI:1205891215
Name:STEPHENS, DONALD E JR (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:STEPHENS
Suffix:JR
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7155
Mailing Address - Country:US
Mailing Address - Phone:575-388-1561
Mailing Address - Fax:575-388-9952
Practice Address - Street 1:2600 N SILVER ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7201
Practice Address - Country:US
Practice Address - Phone:575-388-1889
Practice Address - Fax:575-388-9952
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2022-1340207Q00000X
AZ54351207Q00000X, 207Q00000X
KY40270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100005620Medicaid
INP00309839OtherRAILROAD MEDICARE
IN200454180Medicaid
INP00309839OtherRAILROAD MEDICARE
MD422521ZBCBMedicare PIN
IN200454180Medicaid
KY7100005620Medicaid
IN196290ZMedicare PIN
KYK018242Medicare PIN
KYK018240Medicare PIN