Provider Demographics
NPI:1457395071
Name:EWER, STEPHEN N (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:N
Last Name:EWER
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 1:3900 S ZINTEL WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:1100 GOETHALS DR
Practice Address - Street 2:KADLEC INLAND CARDIOLOGY
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3304
Practice Address - Country:US
Practice Address - Phone:509-946-2699
Practice Address - Fax:509-946-2675
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD20233207RC0000X
WAMD00033936207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0311418OtherL&I
WA1457395071Medicaid
OR209353Medicaid
WA1457395071Medicaid
WA0311418OtherL&I