Provider Demographics
NPI:1770584047
Name:STEVENSON, DONALD V (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:V
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 1:575 E. HARDY ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4040
Mailing Address - Country:US
Mailing Address - Phone:310-674-1211
Mailing Address - Fax:310-674-8668
Practice Address - Street 1:575 E. HARDY ST
Practice Address - Street 2:SUITE 105
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4040
Practice Address - Country:US
Practice Address - Phone:310-674-1211
Practice Address - Fax:310-674-8668
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48296207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G482960Medicaid
CA00G482960Medicaid
CA5348800001Medicare NSC