Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 12159 | MS |
N | 207RG0300X | Geriatric Medicine | 20203 | AL |
NPI | 1124067368 |
---|---|
Provider Name | Thomas E. Stevens JR. |
First Address | Pascagoula, MS 39581-5301 |
Second Address | Pascagoula, MS 39581-5301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 04/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000028907 | (05) | AL |
00121547 | (05) | MS |
04-11062 | UNITED HEALTHCARE (01) | AL |
110144785 | RAILROAD MEDICARE PTAN (01) | AL |
263706500 | (05) | FL |
51028907 | BCBS (01) | AL |
51077048 | BCBS (01) | AL |
51593818 | BCBS - 954 NAVCO RD (01) | AL |
F01028 | (02) |