Provider Demographics
NPI:1396710372
Name:STEVENS, SCOTT ROBERT (MD)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ROBERT
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 PREMIER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-386-6600
Mailing Address - Fax:507-625-5971
Practice Address - Street 1:1431 PREMIER DRIVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-386-6600
Practice Address - Fax:507-625-5971
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41734207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN983181020435OtherPREFERRED ONE
MNHP29328OtherHEALTH PARTNERS
MN0907651OtherMEDICA, MANKATO
MN284088000Medicaid
MN410940705H002OtherTRICARE/WPS
MN123637C572OtherUCARE MN
MN42B11STOtherBCBS OF MN
MN983181020435OtherPREFERRED ONE
MN200035504Medicare ID - Type UnspecifiedPALMETTO GBA, RR MC
MN284088000Medicaid