Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 036.134874 | IL |
Y | 207Q00000X | Family Doctor | 2010003855 | MO |
N | 207QS0010X | Family Doctor - Sports Medicine | 036.134874 | IL |
N | 207QS0010X | Family Doctor - Sports Medicine | 2010003855 | MO |
NPI | 1194987461 |
---|---|
Provider Name | Luke Anthony Stephens |
First Address | Kansas City, MO 64184-3966 |
Second Address | Ashland, MO 65010-1180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 09/05/2019 |