Provider Demographics
NPI:1154374262
Name:STEVENS, SCOTT LAWRENCE (SCOTT STEVENS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:LAWRENCE
Last Name:STEVENS
Suffix:
Gender:M
Credentials:SCOTT STEVENS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ALCOA HWY
Mailing Address - Street 2:BOX U-11
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1511
Mailing Address - Country:US
Mailing Address - Phone:865-544-9289
Mailing Address - Fax:865-690-5771
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:BOX U-11
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-544-9289
Practice Address - Fax:865-690-5771
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD198312086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE48219Medicare UPIN
TN3048788Medicare ID - Type Unspecified