Provider Demographics
NPI:1194987461
Name:STEPHENS, LUKE ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:ANTHONY
Last Name:STEPHENS
Suffix:
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:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:101 REDTAIL DR
Practice Address - Street 2:STE C
Practice Address - City:ASHLAND
Practice Address - State:MO
Practice Address - Zip Code:65010-1136
Practice Address - Country:US
Practice Address - Phone:573-882-9060
Practice Address - Fax:573-657-0122
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.134874207Q00000X, 207QS0010X
MO2010003855207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152360474Medicare PIN