Provider Demographics
NPI:1700881240
Name:STEPHENS, GORDON MARCUS (DO)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:MARCUS
Last Name:STEPHENS
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 1:704 EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTCLIFFE
Mailing Address - State:CO
Mailing Address - Zip Code:81252-8835
Mailing Address - Country:US
Mailing Address - Phone:719-783-2380
Mailing Address - Fax:719-283-2377
Practice Address - Street 1:704 EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:WESTCLIFFE
Practice Address - State:CO
Practice Address - Zip Code:81252-8835
Practice Address - Country:US
Practice Address - Phone:719-783-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0521077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100217800CMedicaid
KS100217800CMedicaid