Provider Demographics
NPI:1124067368
Name:STEVENS, THOMAS E JR (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:STEVENS
Suffix:JR
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 1:2809 DENNY AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5301
Mailing Address - Country:US
Mailing Address - Phone:228-809-5510
Mailing Address - Fax:228-809-5519
Practice Address - Street 1:2809 DENNY AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5301
Practice Address - Country:US
Practice Address - Phone:228-809-5510
Practice Address - Fax:228-809-5519
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20203207RG0300X
MS12159207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51028907OtherBCBS
AL51077048OtherBCBS
AL51593818OtherBCBS - 954 NAVCO RD
AL04-11062OtherUNITED HEALTHCARE
AL000028907Medicaid
AL110144785OtherRAILROAD MEDICARE PTAN
MS00121547Medicaid
FL263706500Medicaid
MS00121547Medicaid
AL000028907Medicare PIN