Provider Demographics
NPI:1669618286
Name:STEVENSON, STEVIE JACK JR
Entity type:Individual
Prefix:MR
First Name:STEVIE
Middle Name:JACK
Last Name:STEVENSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 S PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-5036
Mailing Address - Country:US
Mailing Address - Phone:405-372-7707
Mailing Address - Fax:
Practice Address - Street 1:1322 S PERKINS RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5036
Practice Address - Country:US
Practice Address - Phone:405-372-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology