Provider Demographics
NPI:1124488671
Name:CARL E. STEVENS, M.D., PLLC
Entity type:Organization
Organization Name:CARL E. STEVENS, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-236-9066
Mailing Address - Street 1:PO BOX 10411
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0042
Mailing Address - Country:US
Mailing Address - Phone:479-717-1171
Mailing Address - Fax:479-725-2395
Practice Address - Street 1:8309 PHOENIX AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6141
Practice Address - Country:US
Practice Address - Phone:479-717-1171
Practice Address - Fax:479-725-2395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty