Doctor Name: | MR. KEN TOBIAS STEVENSON |
NPI Number: | 1023168044 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.S.A |
License Number: | |
Business Practice Address: | 4831 Canyon Shore Dr Humble, TX - 773966109 |
Business Phone Number: | 8324288626 |
Business Fax Number: | |
Mailing Address: | 4831 Canyon Shore Dr, HUMBLE |
State: | TX |
Postal Code: | 773966109 |
Phone Number: | 8324288626 |
Fax Number: | |
NPI Enumeration Date: | 01/11/2007 |
NPI Last Update Date: | 11/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |