Provider Demographics
NPI:1649255241
Name:STEVENSON, JON E (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:E
Last Name:STEVENSON
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 1:2075 W PECOS RD
Mailing Address - Street 2:STE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:480-656-5711
Mailing Address - Fax:480-656-5622
Practice Address - Street 1:2075 W PECOS RD
Practice Address - Street 2:STE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-656-5711
Practice Address - Fax:480-656-5622
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ25659207RC0000X, 207RI0011X, 207UN0901X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ445412Medicaid
H09346Medicare UPIN
AZ445412Medicaid