Provider Demographics
NPI:1932402955
Name:LARRY E. STEVENS, M.D.
Entity Type:Organization
Organization Name:LARRY E. STEVENS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL LYNN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-289-6326
Mailing Address - Street 1:120 STATE ST E STE 106
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3647
Mailing Address - Country:US
Mailing Address - Phone:813-855-2969
Mailing Address - Fax:813-891-6931
Practice Address - Street 1:120 STATE ST E STE 106
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3647
Practice Address - Country:US
Practice Address - Phone:813-855-2969
Practice Address - Fax:813-891-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization