Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD19831 | TN |
NPI | 1154374262 |
---|---|
Provider Name | Dr. Scott Lawrence Stevens |
First Address | Knoxville, TN 37920-1511 |
Second Address | Knoxville, TN 37920-1511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E48219 | (02) | TN |