Provider Demographics
NPI:1932531282
Name:SEVIER, STEPHEN (IDC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:SEVIER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459-9305
Mailing Address - Country:US
Mailing Address - Phone:540-241-7345
Mailing Address - Fax:
Practice Address - Street 1:10186 BAUSELL CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-3201
Practice Address - Country:US
Practice Address - Phone:540-241-7345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman