Provider Demographics
NPI:1952351561
Name:STEVENS, EUGENE EARL (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:EARL
Last Name:STEVENS
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 1:637 S 48TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-2328
Mailing Address - Country:US
Mailing Address - Phone:602-274-1952
Mailing Address - Fax:602-274-2338
Practice Address - Street 1:637 S 48TH ST STE 104
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2328
Practice Address - Country:US
Practice Address - Phone:602-274-1952
Practice Address - Fax:602-274-2338
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C24811Medicare UPIN