Provider Demographics
NPI:1770591596
Name:CAIN, STEPHEN R (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:CAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:925 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3955
Mailing Address - Country:US
Mailing Address - Phone:575-523-6330
Mailing Address - Fax:575-523-6331
Practice Address - Street 1:925 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3955
Practice Address - Country:US
Practice Address - Phone:575-523-6330
Practice Address - Fax:575-523-6331
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD-2011-0547207L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46153527Medicaid
NM243426501Medicare UPIN
OK010672601002OtherBCBSOK
NM243426501Medicare UPIN
OK243634002Medicare PIN