Provider Demographics
NPI:1376809202
Name:STEVENS, PAUL KENNETH (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:KENNETH
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 POLE LINE RD W
Mailing Address - Street 2:MAGIC VALLEY WOMEN'S HEALTH CLINIC
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5810
Mailing Address - Country:US
Mailing Address - Phone:208-814-8500
Mailing Address - Fax:208-814-8960
Practice Address - Street 1:801 POLE LINE RD W
Practice Address - Street 2:MAGIC VALLEY WOMEN'S HEALTH CLINIC
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5810
Practice Address - Country:US
Practice Address - Phone:208-814-8500
Practice Address - Fax:208-814-8960
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
IDO-0944207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1376809202OtherNPI