Provider Demographics
NPI:1285608471
Name:STEVENS, DOUGLAS P (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:P
Last Name:STEVENS
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 1:800 ZORN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1433
Mailing Address - Country:US
Mailing Address - Phone:502-287-5105
Mailing Address - Fax:502-287-6964
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1433
Practice Address - Country:US
Practice Address - Phone:502-287-5105
Practice Address - Fax:502-287-6964
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26201208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000048654OtherANTHEM
KY50031672OtherPASSPORT-NORTON REHAB
KY61-1086535OtherTAX ID
KY64262017Medicaid
IN200024170Medicaid
INM400053478OtherMEDICARE PTAN- NORTON REHAB.
KY004333OtherSIHO-NORTON REHAB
KYP400040042OtherKY MEDICARE-NORTON REHAB
KY000057094LOtherHUMANA- NORTON REHAB
KYP00912405OtherRR MEDICARE PTAN-NORTON REHAB
KY000000694447OtherANTHEM-NORTON REHAB
KY1404235OtherCIGNA-NORTON REHAB
KY2432934000OtherPASSPORT ADVANTAGE
KY1050653OtherPASSPORT
IN200024170Medicaid
KY004333OtherSIHO-NORTON REHAB
KY2432934000OtherPASSPORT ADVANTAGE