Provider Demographics
NPI:1386797843
Name:ARCHER, STEPHEN LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LAWRENCE
Last Name:ARCHER
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 1:350 OLSEN CLOSE
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T6R 1L1
Mailing Address - Country:CA
Mailing Address - Phone:780-407-3463
Mailing Address - Fax:780-407-3489
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MAIL CODE 6080, UNIVERSITY OF CHICAGO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-834-9748
Practice Address - Fax:773-702-8875
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36117433282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36117433OtherSTATE LICENSE