Provider Demographics
NPI:1962610279
Name:STEVENSON, DUSTIN ERIN (DO)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:ERIN
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 E CHURCH ST
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-739-3114
Mailing Address - Fax:805-739-3060
Practice Address - Street 1:1325 E CHURCH ST STE 301
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5915
Practice Address - Country:US
Practice Address - Phone:805-349-9393
Practice Address - Fax:805-349-1155
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12043207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology